Delayed orthostatic hypotension in Parkinson's disease and in the general ageing population.

IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Bianca Calió, Fabian Leys, Giulia Matteucci, Nicole Campese, Giulia Rivasi, Georg Göbel, Giuseppe Dario Testa, Roberta Granata, Susanne Dürr, Jean-Pierre Ndayisaba, Karoline Radl, Michael Thurner-Rodriguez, Klaus Seppi, Werner Poewe, Stefan Kiechl, Andrea Ungar, Gregor Wenning, Martina Rafanelli, Alessandra Fanciulli
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Abstract

Objective: Delayed orthostatic hypotension (dOH) is defined by a sustained blood pressure (BP) fall ≥20/10 mmHg occurring beyond 3 minutes in the upright position, whose clinical relevance is yet undetermined. We investigated frequency, associated features and treatment strategies of dOH in Parkinson's Disease (PD) and ageing individuals with history of syncope or orthostatic intolerance.

Methods: We retrospectively studied 213 individuals with PD and 213 age-matched individuals without parkinsonism referred for tilt-table testing to the Innsbruck and Florence Dysautonomia centres. In both cohorts, we reviewed the medical records of the 6 months before testing for history of syncope and falls, and of the 6 months afterwards for the recommended dOH treatment and clinical outcome.

Results: dOH was twice as frequent in PD than in ageing individuals [18% versus 9%; OR = 2.9 (95 CI.: 1.3-6.5), P = .007]. Upon prolonged head-up tilt, PD individuals showed a more severe systolic BP fall (P < .001). PD individuals with history of syncope also exhibited a sustained systolic BP fall from the 3rd minute of head-up tilt onward compared to those without (P = .014). Both non-pharmacological and pharmacological OH treatment strategies were associated with symptomatic improvement at follow-up.

Conclusions: In PD individuals referred to tertiary settings, tilt-table testing more frequently disclosed dOH compared to age-matched individuals without parkinsonism. In PD, dOH is mainly driven by a progressive orthostatic systolic BP fall, increasing the risk of syncope. Given its prevalence and the potential for effective treatment, dOH should be actively screened for in clinical practice.

帕金森病和一般老年人群的迟发性体位性低血压
目的:迟发性直立性低血压(dOH)是指直立体位持续血压(BP)下降≥20/10 mmHg,持续时间超过3分钟,其临床意义尚不确定。我们调查了帕金森病(PD)和有晕厥或站立不耐受史的老年人dOH的频率、相关特征和治疗策略。方法:我们回顾性研究了213名PD患者和213名年龄匹配的无帕金森患者,他们被转到因斯布鲁克和佛罗伦萨自主神经障碍中心进行倾斜试验。在这两个队列中,我们回顾了检测晕厥和跌倒史前6个月的医疗记录,以及推荐的dOH治疗和临床结果后6个月的医疗记录。结果:PD患者的dOH发生率是老年人的两倍[18%对9%;Or = 2.9 (95 ci。: 1.3-6.5), p = .007]。在长时间抬头倾斜时,PD患者表现出更严重的收缩压下降(P结论:与年龄匹配的无帕金森患者相比,在第三阶段PD患者中,倾斜试验更频繁地显示dOH。在PD中,dOH主要是由进行性直立性收缩期血压下降引起的,增加了晕厥的风险。鉴于其患病率和有效治疗的潜力,dOH应在临床实践中积极筛查。
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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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