Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1620, USA.
J Neurol Sci. 2011 Nov 15;310(1-2):123-8. doi: 10.1016/j.jns.2011.06.047. Epub 2011 Jul 16.
Non-motor aspects of Parkinson disease (PD) are now recognized to be important both clinically and scientifically. Among these facets are abnormalities in blood pressure regulation. As much as 40% of PD patients have orthostatic hypotension (OH), which is usually associated with supine hypertension (SH). Symptoms of OH range from light-headedness to falls with serious trauma. SH, while typically asymptomatic, poses a significant increased risk for cardiovascular morbidity and mortality. Neuroimaging, neurochemical, and neuropharmacological studies indicate cardiac and extra-cardiac sympathetic noradrenergic denervation and baroreflex failure in virtually all PD patients with OH, and cardiac sympathetic denervation has been confirmed histopathologically. Mechanisms of SH in PD+OH remain poorly understood. The diurnal blood pressure profile shows increased variability that is correlated with decreased baroreflex gain and with increased morbidity and mortality. Treatment should be individually tailored according to the timing of OH or SH, using primarily short-acting sympathomimetic medications in the daytime for OH and short-acting antihypertensive in the nighttime for SH. Future research is needed to understand better and attenuate blood pressure fluctuations through manipulations that improve baroreflex function.
帕金森病（PD）的非运动方面现在在临床和科学上都被认为是重要的。这些方面包括血压调节异常。多达 40%的 PD 患者患有直立性低血压（OH），通常与仰卧位高血压（SH）有关。OH 的症状从头晕到跌倒，严重时会造成创伤。SH 虽然通常无症状，但会显著增加心血管发病率和死亡率的风险。神经影像学、神经化学和神经药理学研究表明，几乎所有患有 OH 的 PD 患者都存在心脏和心脏外交感去神经支配和压力反射失败，并且已经通过组织病理学证实了心脏交感神经支配。PD+OH 中 SH 的机制仍知之甚少。昼夜血压谱显示出变异性增加，与压力反射增益降低以及发病率和死亡率增加相关。根据 OH 或 SH 的时间，应根据个人情况进行治疗，白天使用短效拟交感神经药物治疗 OH，夜间使用短效降压药治疗 SH。需要进一步的研究来更好地理解和减轻血压波动，通过改善压力反射功能的操作来实现。
