Clinical Autonomic Research最新文献

{"title":"Improvement in nocturnal blood pressure with bedtime antihypertensive administration in older adults aged 65 and above: a systematic review and meta-analysis.","authors":"Jordy Saren, Siddhartha Lieten, Mirko Petrovic, Esma Islamaj, Ivan Bautmans, Aziz Debain","doi":"10.1007/s10286-025-01159-z","DOIUrl":"https://doi.org/10.1007/s10286-025-01159-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the effectiveness of morning versus bedtime antihypertensive medication administration in reducing ambulatory blood pressure (BP) in older adults aged ≥ 65, and to assess whether administration timing influences conversion from a non-dipper to a dipper BP profile.</p><p><strong>Methods: </strong>Eight randomized controlled trials were identified through systematically screening of the PubMed and Web of Science databases. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analyses were conducted with Review Manager version 5.4 to compare the efficacy of morning versus bedtime administration on ambulatory BP indices.</p><p><strong>Results: </strong>Bedtime administration resulted in significantly greater reductions in nocturnal systolic BP (mean difference [MD] - 4.52 mmHg, [lower and upper 95% confidence intervals [CI] - 7.15; - 1.90]; p = 0.0007) and diastolic BP (MD - 2.00 mmHg, [95% CI - 2.90; - 1.10]; p < 0.0001). No significant differences were observed in diurnal systolic BP (MD 1.28 mmHg, [95% CI - 0.17; 2.72]; p = 0.08), diastolic BP (MD 0.34 mmHg, [95% CI - 0.49; 1.16]; p = 0.42), 24/48-h systolic BP (MD - 0.02 mmHg, [95% CI - 1.37; 1.33]; p = 0.98), or 24/48-h diastolic BP (MD - 0.50 mmHg, [95% CI - 1.45; 0.45]; p = 0.30). Sensitivity analysis excluding the controversial data from Hermida confirmed significantly greater reductions in nocturnal systolic and diastolic BP with bedtime administration. Two of three studies reported that bedtime administration was associated with a lower proportion of non-dippers than morning treatment.</p><p><strong>Conclusion: </strong>Bedtime antihypertensive administration improves control of nocturnal BP in older adults aged ≥ 65 and may facilitate restoration to a dipper BP profile. No significant differences were observed in diurnal or 24/48-h mean BP reductions compared with morning administration.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthostatic cerebral hypoperfusion syndrome: an uncommon cause of orthostatic intolerance in a patient with COVID-19.","authors":"Jie Zhang, Yao Wang, Lijuan Wang","doi":"10.1007/s10286-025-01162-4","DOIUrl":"https://doi.org/10.1007/s10286-025-01162-4","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous indices correlate with baroreflex gain only in adults with spinal cord injury.","authors":"Jason W Hamner, Adina Draghici, Daniela Martinez-Magallanes, J Andrew Taylor","doi":"10.1007/s10286-025-01158-0","DOIUrl":"https://doi.org/10.1007/s10286-025-01158-0","url":null,"abstract":"<p><strong>Purpose: </strong>Spontaneous indices have been widely used to assess baroreflex gain despite their numerous limitations and concerns regarding their validity, reliability, and reproducibility. In this retrospective study, we investigated whether spontaneous baroreflex indices reflect cardiovagal baroreflex gain assessed by the neck-chamber technique in those with spinal cord injury (SCI) and in uninjured individuals. SCI represents a model of preserved cardiovagal baroreflex control coupled with impaired sympathetic effects on the vasculature.</p><p><strong>Methods: </strong>We derived three spontaneous indices of baroreflex sensitivity (sequence method, low-frequency (LF), and high-frequency (HF) transfer function) and compared them with baroreflex gain obtained via the neck-chamber technique in adults with SCI (n = 29; neurological level C1-T10, ≤ 2 years since injury) and uninjured adults (n = 14).</p><p><strong>Results: </strong>In both groups, spontaneous indices were highly correlated with each other (all p < 0.01). In uninjured participants, neck suction baroreflex gain did not relate to any spontaneous index. In individuals with SCI, neck-chamber gain correlated significantly with spontaneous indices (all r > 0.43, p < 0.05); these relationships were significantly stronger in individuals with neurologically complete injuries (sequence: r = 0.67, p < 0.01; LF: r = 0.79, p < 0.001; HF: r = 0.76, p < 0.001). However, Bland-Altman analysis revealed a strong proportional bias, with spontaneous indices consistently and progressively overestimating neck-chamber gain (all r > 0.91, p < 0.001).</p><p><strong>Conclusions: </strong>These results suggest that sympathetic activity is largely responsible for the lack of correspondence between spontaneous and neck-chamber baroreflex gains. However, even in individuals with a neurologically complete SCI, where sympathetic influences are minimal, spontaneous indices may not consistently reflect baroreflex gain derived from other methods.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3,4-Dihydroxyphenylglycol levels separate multiple system atrophy from Parkinson disease with orthostatic hypotension.","authors":"David S Goldstein, Patti Sullivan, Courtney Holmes","doi":"10.1007/s10286-025-01150-8","DOIUrl":"https://doi.org/10.1007/s10286-025-01150-8","url":null,"abstract":"<p><strong>Background: </strong>The autonomic synucleinopathy multiple system atrophy (MSA) can be difficult to distinguish clinically from Parkinson disease with orthostatic hypotension (PD+OH). ¹⁸F-Dopamine positron emission tomography separates these conditions based on cardiac noradrenergic deficiency in PD+OH and not in MSA but is available only at the NIH Clinical Center. 3,4-Dihydroxyphenylglycol (DHPG) is the main neuronal metabolite of norepinephrine. This retrospective observational study examined whether DHPG levels in cerebrospinal fluid (CSF) or plasma differentiate MSA from PD+OH.</p><p><strong>Methods: </strong>We reviewed CSF and plasma neurochemical data from all patients referred for evaluation at the NIH Clinical Center between 1995 and 2024 for chronic autonomic failure or parkinsonism. A concurrently studied comparison group included healthy volunteers or patients with orthostatic intolerance.</p><p><strong>Results: </strong>CSF DHPG was decreased in MSA (N = 67, p < 0.0001) compared to the controls but also tended to be decreased in PD+OH (N = 31, p = 0.0776). Antecubital venous plasma DHPG was decreased in PD+OH (N = 47, p = 0.0064) but not in MSA. CSF/plasma concentration ratios of DHPG were lower in MSA than in PD+OH (p = 0.0005). Cardiac arteriovenous increments in plasma DHPG and cardiac norepinephrine spillovers were strikingly decreased in PD+OH (N = 6) and were lower than in MSA (N = 20, p < 0.0001 each). Combining cardiac arteriovenous increments in plasma DHPG with norepinephrine spillovers completely separated PD+OH from MSA.</p><p><strong>Conclusions: </strong>CSF/plasma ratios of DHPG, cardiac arteriovenous increments in plasma DHPG, and cardiac norepinephrine spillovers separate MSA from PD+OH. On the basis of our results we propose that biomarker combinations involving DHPG in biofluids may enable a clinical laboratory distinction of MSA from PD+OH.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"QSART and Q-Sweat normative data mismatch: a critical review of the clinical autonomic literature.","authors":"Soo Hwan Park, David M Sletten, Nathaniel M Robbins","doi":"10.1007/s10286-025-01157-1","DOIUrl":"https://doi.org/10.1007/s10286-025-01157-1","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular autonomic failure correlates with cutaneous autonomic denervation in PD and MSA.","authors":"Shiwen Koay, Vincenzo Provitera, Ekawat Vichayanrat, Giuseppe Caporaso, Fernanda Valerio, Annamaria Stancanelli, Ilaria Borreca, Fiore Manganelli, Lucio Santoro, Maria Nolano, Valeria Iodice","doi":"10.1007/s10286-025-01154-4","DOIUrl":"https://doi.org/10.1007/s10286-025-01154-4","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiovascular autonomic failure and neurogenic orthostatic hypotension (nOH) are common and disabling in Parkinson's disease (PD) and multiple system atrophy (MSA). Recent studies have shown evidence of postganglionic autonomic denervation in MSA as well as PD. We aimed to characterise the relationship between nOH, autonomic failure and postganglionic denervation in PD and MSA. We hypothesised that postganglionic autonomic denervation contributes to the development of nOH and correlates with the severity of cardiovascular autonomic failure.</p><p><strong>Methods: </strong>We assessed 57 patients (37 PD, 20 MSA, median 64 [IQR 59-70] years) with cardiovascular autonomic testing; dynamic sweat testing; plasma noradrenaline levels; skin biopsies for quantification of intraepidermal, pilomotor and sudomotor innervation; and autonomic symptom questionnaires.</p><p><strong>Results: </strong>Overall, 78% of patients with MSA and 36% with PD had nOH ≥ 20/10 mmHg. The MSA group had more severe nOH, sudomotor dysfunction and cutaneous denervation, with higher supine noradrenaline than the PD group. Only supine noradrenaline differed between MSA and PD with nOH subgroups (P = 0.04). Overall, patients with nOH demonstrated more severe (1) cardiovascular autonomic failure, with reduced pressor responses to isometric exercise, deep breathing and Valsalva ratio; (2) intraepidermal, pilomotor and sudomotor denervation; and (3) autonomic symptoms and Hoehn-Yahr grade. The severity of nOH and cardiovascular autonomic failure correlated with autonomic denervation, patient symptoms and Hoehn-Yahr grade (ρ ≥ 0.50).</p><p><strong>Conclusions: </strong>nOH was associated with cutaneous autonomic denervation in both PD and MSA, with correlations between cardiovascular autonomic failure, cutaneous denervation and Hoehn-Yahr grade. Postganglionic autonomic denervation may contribute to nOH in PD and MSA, and affect responses to therapeutic agents.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthostatic hypotension in Parkinson's disease-More than just lightheadedness and fainting.","authors":"Guillaume Lamotte","doi":"10.1007/s10286-025-01155-3","DOIUrl":"https://doi.org/10.1007/s10286-025-01155-3","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral autoregulation in orthostatic hypotension and falls among older adults: a community-based exploratory study.","authors":"Nor Izzati Saedon, James Frith, Wan Azman Wan Ahmad, Maw Pin Tan","doi":"10.1007/s10286-025-01152-6","DOIUrl":"https://doi.org/10.1007/s10286-025-01152-6","url":null,"abstract":"<p><strong>Background: </strong>Orthostatic hypotension (OH) is prevalent in older adults and is often associated with falls. However, the presence or absence of symptoms in OH may be mediated by cerebral autoregulation, which helps maintain cerebral perfusion during blood pressure fluctuations.</p><p><strong>Methods: </strong>We recruited 40 older adults (aged ≥ 55 years) from the Malaysian Elders Longitudinal Research (MELoR) cohort. Participants underwent cerebral blood flow velocity monitoring using transcranial Doppler ultrasonography and beat-to-beat blood pressure recording. Three protocols were used: active stand, mental arithmetic, and Valsalva manoeuvre. Participants were categorized, based on OH (≥ 30 mmHg systolic drop) and fall history, into four groups. Cerebrovascular resistance (CVR) was derived and analysed.</p><p><strong>Results: </strong>Participants with OH but no history of falls demonstrated preserved autoregulatory responses, as reflected by adaptive reductions in CVR. In contrast, fallers-regardless of OH status-had impaired CVR modulation. Significant group differences were found during the active stand test at 165 s and 180 s (p < 0.05).</p><p><strong>Conclusion: </strong>Preserved cerebral autoregulation may protect older adults with OH from symptomatic manifestations such as falls. Targeting cerebral autoregulation could offer novel approaches for preventing falls in this population.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the relationship between orthostatic hypotension and gait in people with Parkinson's disease.","authors":"Tuhin Virmani, Rebecca D Jones, Lakshmi Pillai","doi":"10.1007/s10286-025-01149-1","DOIUrl":"https://doi.org/10.1007/s10286-025-01149-1","url":null,"abstract":"<p><strong>Purpose: </strong>Orthostatic hypotension (OH) is a non-motor feature in people with Parkinson's disease that can lead to falls from syncope. Current knowledge is lacking on the effects of OH on gait function.</p><p><strong>Methods: </strong>Participants enrolled in a prospectively monitored longitudinal cohort who had OH on vitals at one of two consecutive visits approximately 6 months apart were analyzed. Gait measures were compared at the orthostatic versus non-orthostatic visit using the Wilcoxon signed-rank test and a linear mixed model. Motor and non-motor assessments were also compared.</p><p><strong>Results: </strong>Thirty-nine people with Parkinson's disease and seven age-matched controls in the longitudinal study met the inclusion criteria. Mean stride length and foot-strike length were shorter, and stride velocity was slower at the orthostatic visit compared to the non-orthostatic visit in people with Parkinson's disease. Levodopa dose, duration from last dose, motor and total Unified Parkinson's Disease Rating Scale scores, and cognitive and non-motor assessment scores did not differ between visits. The number of people reporting falls was higher at the orthostatic visit, and the fall frequency in fallers also trended higher. Gait measures did not differ between those with and without symptomatic OH.</p><p><strong>Conclusion: </strong>In our cohort of people with Parkinson's disease with repeated measures, gait was more parkinsonian (slower velocity, shorter stride, and decreased foot strike to the ground) when they had OH on vitals at the visit than when they did not. Based on our results, future studies exploring the impact of adequate treatment of OH on gait function are warranted.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of myasthenia gravis with takotsubo cardiomyopathy presenting with respiratory and cardiac arrest.","authors":"Chunhua Hu, Suya Bao, Jianwen Lin, Shumin Li, Lu Wang, Wenxin Liu, Ziqi Han, Yi Liu","doi":"10.1007/s10286-025-01156-2","DOIUrl":"https://doi.org/10.1007/s10286-025-01156-2","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}