Department of Neurology, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Department of Neurology, Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan.
Clin Auton Res. 2021 Jun;31(3):425-431. doi: 10.1007/s10286-020-00758-2. Epub 2021 Jan 26.
Delayed orthostatic hypotension (DOH), a fall in blood pressure after a 3-min cutoff, is clinically meaningful. The aim of this study was to elucidate the clinical and neuroendocrinological characteristics of DOH in patients with Parkinson's disease (PD).
A total of 132 patients with newly diagnosed PD were enrolled. Baseline clinical characteristics, including olfactory function, and changes in norepinephrine (NE) and vasopressin (ADH) concentrations during the head-up tilt test (HUT), were examined.
Fifty-five patients (42%) had classical orthostatic hypotension (COH), and 19 patients (14%) had DOH. Patients with COH and DOH tended to have more severe hyposmia than patients without OH. A multivariate linear regression model showed that hyposmia was associated with DOH and COH. The increase of heart rate against the fall in blood pressure was significantly lower in patients with COH and DOH than those without OH. The NE levels at supine rest and after upright tilting were lower in the COH group than in the PD without OH and DOH groups. The levels of ADH were higher in the DOH group than in the COH group at supine rest and higher than in the PD without OH group after upright tilting. There was no significant difference in the cardiac I-MIBG scintigraphy between the COH and DOH groups.
Compared with patients without OH, patients with DOH had severe hyposmia. Relatively preserved peripheral sympathetic nervous system function in patients with DOH suggests that DOH might be an early and milder form of OH in PD.
直立位低血压（DOH）是指 3 分钟后血压下降，具有临床意义。本研究旨在阐明帕金森病（PD）患者 DOH 的临床和神经内分泌特征。
共纳入 132 例新诊断的 PD 患者。检查了基线临床特征，包括嗅觉功能，以及在头高位倾斜试验（HUT）期间去甲肾上腺素（NE）和血管加压素（ADH）浓度的变化。
55 例（42%）患者有典型直立性低血压（COH），19 例（14%）患者有 DOH。COH 和 DOH 患者的嗅觉障碍比无 OH 患者更严重。多元线性回归模型显示，嗅觉障碍与 DOH 和 COH 有关。COH 和 DOH 患者的心率对血压下降的反应明显低于无 OH 患者。COH 组在仰卧位和直立倾斜后的 NE 水平低于 PD 无 OH 和 DOH 组。在仰卧位时，DOH 组的 ADH 水平高于 COH 组，直立倾斜后高于 PD 无 OH 组。COH 和 DOH 组之间的心脏 I-MIBG 闪烁显像无显著差异。
与无 OH 患者相比，DOH 患者有严重的嗅觉障碍。DOH 患者周围交感神经系统功能相对保留，提示 DOH 可能是 PD 中较早期和较轻的 OH 形式。
