Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic?. (December 2016)

• Record Type: Journal Article
• Authors: Merola, Aristide; Romagnolo, Alberto; Rosso, Michela; Lopez-Castellanos, José Ricardo; Wissel, Benjamin D.; Larkin, Sydney; Bernardini, Andrea; Zibetti, Maurizio; Maule, Simona; Lopiano, Leonardo; Espay, Alberto J.
• Is Part Of: Parkinsonism & related disorders. Volume 33(2016)
• Page Start: 65
• Page End: 71
• Publication Date: 2016-12
• Subjects: Parkinson's disease -- Autonomic -- Syncope -- Orthostatic hypotension -- Supine hypertension; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2016.09.013
• Languages: English
• ISSNs: 1353-8020

Abstract

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. Highlights: Orthostatic hypotension (OH) prevalence in an unselected PD population was 31%. 38% of PD patients with OH did not report orthostatic symptoms. Asymptomatic and symptomatic OH yielded similar functional impairments and rate of falls. There was a trend toward increasing functional disability with worsening OH severity. Screening for OH in PD patients regardless of postural lightheadedness is warranted.