Fanciulli Alessandra, Göbel Georg, Ndayisaba Jean Pierre, Granata Roberta, Duerr Susanne, Strano Stefano, Colosimo Carlo, Poewe Werner, Pontieri Francesco E, Wenning Gregor K
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Rome, Italy.
Clin Auton Res. 2016 Apr;26(2):97-105. doi: 10.1007/s10286-015-0336-4. Epub 2016 Jan 22.
Supine hypertension (SH) is a feature of cardiovascular autonomic failure that often accompanies orthostatic hypotension and may represent a negative prognostic factor in parkinsonian syndromes. Here we investigated the frequency rate as well as the clinical and tilt test correlates of SH in Parkinson's disease (PD) and multiple system atrophy (MSA).
197 PD (33 demented) and 78 MSA (24 MSA-Cerebellar, 54 MSA-Parkinsonian) patients who had undergone a tilt test examination were retrospectively included. Clinical-demographic characteristics were collected from clinical records at the time of the tilt test examination.
SH (>140 mmHg systolic, >90 mmHg diastolic) occurred in 34 % of PD patients (n = 66, mild in 71 % of patients, moderate in 27 %, severe in 2 %) and 37 % of MSA ones (n = 29, mild in 55 % of patients, moderate in 17 %, severe in 28 %). No difference was observed in SH frequency between demented versus gender-, age- and disease duration-matched non-demented PD patients, or between patients with the parkinsonian (MSA-P) versus the cerebellar (MSA-C) variant of MSA. In PD, SH was associated with presence of cardiovascular comorbidities (p = 0.002) and greater systolic (p = 0.007) and diastolic (p = 0.002) orthostatic blood pressure fall. Orthostatic hypotension (p = 0.002), and to a lesser degree, lower daily dopaminergic intake (p = 0.01) and use of anti-hypertensive medications (p = 0.04) were associated with SH in MSA.
One-third of PD and MSA patients suffer from mild to severe SH, independently of age, disease duration or stage. In PD, cardiovascular comorbidities significantly contribute to the development of SH, while in MSA, SH appears to reflect cardiovascular autonomic failure.
仰卧位高血压（SH）是心血管自主神经功能衰竭的一个特征，常伴有体位性低血压，可能是帕金森综合征的一个不良预后因素。在此，我们调查了帕金森病（PD）和多系统萎缩（MSA）中SH的发生率以及临床和倾斜试验相关性。
回顾性纳入197例接受倾斜试验检查的PD患者（33例痴呆）和78例MSA患者（24例MSA-小脑型，54例MSA-帕金森型）。从倾斜试验检查时的临床记录中收集临床人口统计学特征。
34%的PD患者（n = 66）出现SH（收缩压>140 mmHg，舒张压>90 mmHg），其中71%为轻度，27%为中度，2%为重度；37%的MSA患者（n = 29）出现SH，其中55%为轻度，17%为中度，28%为重度。在痴呆的PD患者与性别、年龄和病程匹配的非痴呆PD患者之间，或MSA的帕金森型（MSA-P）与小脑型（MSA-C）患者之间，SH发生率无差异。在PD中，SH与心血管合并症的存在（p = 0.002）以及更大的收缩期（p = 0.007）和舒张期（p = 0.002）体位性血压下降相关。体位性低血压（p = 0.002），以及程度较轻的每日多巴胺能摄入量较低（p = 0.01）和使用抗高血压药物（p = 0.04）与MSA中的SH相关。
三分之一的PD和MSA患者患有轻度至重度SH，与年龄、病程或疾病阶段无关。在PD中，心血管合并症显著促成SH的发生，而在MSA中，SH似乎反映了心血管自主神经功能衰竭。
