title: Clinical characteristics of supine hypertension in de novo Parkinson disease.
abstract: OBJECTIVE
  Supine hypertension is frequently associated with autonomic failure. However, its clinical characteristics in patients with Parkinson disease (PD) remain unclear. The present study aimed to clarify the characteristics of supine hypertension in patients with de novo PD.
  
  
  METHODS
  The subjects were 72 patients with de novo PD. We studied blood pressure and plasma norepinephrine levels after the patients rested for 20 min in the supine position. Changes in blood pressure were also examined on head-up tilt-table testing.
  
  
  RESULTS
  The disease duration was 1.7 ± 1.6 years (average ± SD). Thirty-three (45.8 %) patients had supine hypertension (defined as a blood pressure of ≥140/90 mmHg). Supine blood pressure positively correlated with the degree of orthostatic hypotension. Age and the proportion of patients with akinetic-rigid motor subtype or preexisting hypertension were higher among patients with supine hypertension than among those without supine hypertension. The Mini-Mental State Examination score was lower in patients with supine hypertension than in those without supine hypertension. Sex, disease duration, disease severity, and peripheral sympathetic nervous activity as evaluated by the cardiac uptake of (123)I-metaiodobenzylguanidine and the plasma norepinephrine level did not differ between patients with and those without supine hypertension.
  
  
  CONCLUSIONS
  Older age, akinetic-rigid motor subtype, and preexisting hypertension are independent risk factors for supine hypertension. Supine hypertension alone may be associated with milder peripheral sympathetic nervous denervation than orthostatic hypotension alone. As for global cognitive decline, supine hypertension is a far riskier comorbidity of early-stage PD than is orthostatic hypotension.
authors.affiliation: Department of Neurology, Daisan Hospital, The Jikei University School of Medicine, 4-11-1 Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan. tumety@jikei.ac.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Umehara
authors.affiliation: Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Matsuno
authors.affiliation: Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Toyoda
authors.affiliation: Department of Neurology, Daisan Hospital, The Jikei University School of Medicine, 4-11-1 Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan. h.oka@jikei.ac.jp.
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Oka
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology*; D016683:Supine Position; D018667:Tilt-Table Test
keywords: Autonomic failure; Orthostatic hypotension; Parkinson’s disease; Supine hypertension; Tilt-table testing