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Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic?
Parkinsonism Relat Disord. 2016 12; 33:65-71.PR

Abstract

INTRODUCTION

Orthostatic hypotension (OH) may frequently be asymptomatic in patients with Parkinson's disease (PD). However, the relationship between symptomatic/asymptomatic status and functional disability remains unclear.

METHODS

Using orthostatic blood pressure (BP) measurements and the Orthostatic Hypotension Symptom Assessment (OHSA) questionnaire, 121 consecutive PD patients without history of chronic hypertension and not taking alpha-adrenergic antagonists for bladder disorders were classified according to (1) OH symptomatic status, based on presence/absence of orthostatic symptoms (symptomatic OH: OHSA item 1 ≥ 1), and (2) OH severity, based on the magnitude of BP fall on the lying-to-standing test: OH- (<20/10 mmHg); moderate OH+ (≥20/10 mmHg but < 30/15 mmHg); and severe OH+ (≥30/15 mmHg). The primary endpoints were the activities of daily living/instrumental activities of daily living (ADL/iADL) and the Ambulatory Capacity Measure (ACM). Secondary endpoints included PD quality of life (PDQ-8) and prevalence of falls.

RESULTS

The overall prevalence of OH+ was 30.6% (37/121 patients), with 62.2% symptomatic (23/37) and 37.8% asymptomatic (14/37). Symptomatic and asymptomatic OH + patients had similar impairments in ADL/iADL and ACM, significantly worse than OH- (p ≤ 0.035). There was a trend for worse ADL/iADL and ACM scores in severe OH + compared to moderate OH+, but both were worse than OH- (p ≤ 0.048). Symptomatic and asymptomatic OH + showed similar impairment in PDQ-8 and higher prevalence of falls compared to OH-.

CONCLUSIONS

Asymptomatic OH+ was associated with similar impairments in ADL/iADL and ACM than symptomatic OH+. These findings support screening for OH in PD patients regardless of postural lightheadedness.

Authors+Show Affiliations

Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA. Electronic address: merolaae@ucmail.uc.edu.Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Torino, Italy.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Torino, Italy.Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Torino, Italy.Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Corso Bramante 88, 10126, Torino, Italy.Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Torino, Italy.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27641792

Citation

Merola, Aristide, et al. "Orthostatic Hypotension in Parkinson's Disease: Does It Matter if Asymptomatic?" Parkinsonism & Related Disorders, vol. 33, 2016, pp. 65-71.
Merola A, Romagnolo A, Rosso M, et al. Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic? Parkinsonism Relat Disord. 2016;33:65-71.
Merola, A., Romagnolo, A., Rosso, M., Lopez-Castellanos, J. R., Wissel, B. D., Larkin, S., Bernardini, A., Zibetti, M., Maule, S., Lopiano, L., & Espay, A. J. (2016). Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic? Parkinsonism & Related Disorders, 33, 65-71. https://doi.org/10.1016/j.parkreldis.2016.09.013
Merola A, et al. Orthostatic Hypotension in Parkinson's Disease: Does It Matter if Asymptomatic. Parkinsonism Relat Disord. 2016;33:65-71. PubMed PMID: 27641792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic? AU - Merola,Aristide, AU - Romagnolo,Alberto, AU - Rosso,Michela, AU - Lopez-Castellanos,José Ricardo, AU - Wissel,Benjamin D, AU - Larkin,Sydney, AU - Bernardini,Andrea, AU - Zibetti,Maurizio, AU - Maule,Simona, AU - Lopiano,Leonardo, AU - Espay,Alberto J, Y1 - 2016/09/10/ PY - 2016/07/31/received PY - 2016/08/31/revised PY - 2016/09/10/accepted PY - 2016/9/20/pubmed PY - 2018/2/8/medline PY - 2016/9/20/entrez KW - Autonomic KW - Orthostatic hypotension KW - Parkinson's disease KW - Supine hypertension KW - Syncope SP - 65 EP - 71 JF - Parkinsonism & related disorders JO - Parkinsonism Relat Disord VL - 33 N2 - INTRODUCTION: Orthostatic hypotension (OH) may frequently be asymptomatic in patients with Parkinson's disease (PD). However, the relationship between symptomatic/asymptomatic status and functional disability remains unclear. METHODS: Using orthostatic blood pressure (BP) measurements and the Orthostatic Hypotension Symptom Assessment (OHSA) questionnaire, 121 consecutive PD patients without history of chronic hypertension and not taking alpha-adrenergic antagonists for bladder disorders were classified according to (1) OH symptomatic status, based on presence/absence of orthostatic symptoms (symptomatic OH: OHSA item 1 ≥ 1), and (2) OH severity, based on the magnitude of BP fall on the lying-to-standing test: OH- (<20/10 mmHg); moderate OH+ (≥20/10 mmHg but < 30/15 mmHg); and severe OH+ (≥30/15 mmHg). The primary endpoints were the activities of daily living/instrumental activities of daily living (ADL/iADL) and the Ambulatory Capacity Measure (ACM). Secondary endpoints included PD quality of life (PDQ-8) and prevalence of falls. RESULTS: The overall prevalence of OH+ was 30.6% (37/121 patients), with 62.2% symptomatic (23/37) and 37.8% asymptomatic (14/37). Symptomatic and asymptomatic OH + patients had similar impairments in ADL/iADL and ACM, significantly worse than OH- (p ≤ 0.035). There was a trend for worse ADL/iADL and ACM scores in severe OH + compared to moderate OH+, but both were worse than OH- (p ≤ 0.048). Symptomatic and asymptomatic OH + showed similar impairment in PDQ-8 and higher prevalence of falls compared to OH-. CONCLUSIONS: Asymptomatic OH+ was associated with similar impairments in ADL/iADL and ACM than symptomatic OH+. These findings support screening for OH in PD patients regardless of postural lightheadedness. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/27641792/Orthostatic_hypotension_in_Parkinson's_disease:_Does_it_matter_if_asymptomatic DB - PRIME DP - Unbound Medicine ER -