title: Neurogenic orthostatic hypotension and supine hypertension in Parkinson's disease and related synucleinopathies: prioritisation of treatment targets.
abstract: Neurogenic orthostatic hypotension and supine hypertension are common manifestations of cardiovascular dysautonomia in Parkinson's disease and related synucleinopathies. Because these disorders are haemodynamic opposites, improvement in one might be achieved at the expense of worsening of the other. Thus, management decisions necessitate assessment of the individual risks for patients with coexistent neurogenic orthostatic hypotension and supine hypertension. Whereas neurogenic orthostatic hypotension poses risks for falls and can be associated with cognitive impairment in the short term, chronic supine hypertension can be associated with stroke and myocardial infarction in the long term. Because few clinical trial data exist for outcomes in patients with coexistent neurogenic orthostatic hypotension and supine hypertension, clinicians need to balance, on the basis of comorbidities and disease staging, the potential immediate benefits of treatment for neurogenic orthostatic hypotension and the long-term risks of supine hypertension treatment in each patient. Future research needs to focus on ascertaining a safe degree of supine hypertension when treating neurogenic orthostatic hypotension; the effectiveness of nocturnal antihypertensive therapy in patients with coexistent neurogenic orthostatic hypotension and supine hypertension; and the prevalence, scope, and therapeutic requirements for managing neurogenic orthostatic hypotension that manifests with falls or cognitive impairment, but without postural lightheadedness or near syncope.
authors.affiliation: Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA. Electronic address: alberto.espay@uc.edu.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
authors.affiliation: Parkinson's Disease and Movement Disorders Program, Henry Ford Hospital, West Bloomfield, MI, USA; Department of Neurology, Wayne State University School of Medicine, West Bloomfield, MI, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: LeWitt
authors.affiliation: USF Health Byrd NPF Parkinson's Disease and Movement Disorders Center of Excellence, Tampa, FL, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hauser
authors.affiliation: Department of Neuroscience, University of Torino, Torino, Italy.
authors.forename: Aristide
authors.initials: A
authors.lastname: Merola
authors.affiliation: Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Masellis
authors.affiliation: Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000209:etiology; D015259:Dopamine Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007024:Hypotension, Orthostatic / Q000209:etiology*; D008297:Male; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D051843:Synucleins / Q000378:metabolism*
chemical_list: D015259:Dopamine Agents; D051843:Synucleins