Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium.
Frailty in Aging (FRIA) investigation group, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium.
BMC Geriatr. 2021 Mar 1;21(1):148. doi: 10.1186/s12877-021-02059-3.
Orthostatic hypotension (OH) in geriatric patients frequently involves a component of autonomic failure (AF). The combination of OH with nocturnal hypertension (NHT) is indicative of AF, which is described as pure (PAF), when neurologic symptoms are absent, or as multisystem atrophy (MSA), when combined with motor disturbance (Parkinsonism or Parkinson disease).
An 87-year-old man presented with long-lasting OH. He frequently fell, causing several fractures, and he developed heart failure. Blood pressure (BP) registration revealed a reversal of the day-night rhythm with NHT. An 18-FDG PET brain CT scan showed cerebellar hypometabolism, indicating MSA.
This case demonstrates the use of continuous BP registration in geriatric patients with OH for diagnosing NHT. It illustrates the usefulness of 18-FDG PET brain CT scan to specify the nature of the AF. The case also illustrates the difficulty of managing the combination of OH and NHT.
老年患者的体位性低血压（OH）常涉及自主神经衰竭（AF）的一个组成部分。OH 与夜间高血压（NHT）的组合表明存在 AF，当没有神经症状时称为单纯自主神经衰竭（PAF），当伴有运动障碍（帕金森病或帕金森病）时称为多系统萎缩（MSA）。
一位 87 岁男性出现长期 OH。他经常跌倒，导致多处骨折，并出现心力衰竭。血压（BP）记录显示 NHT 出现昼夜节律逆转。18-FDG PET 脑 CT 扫描显示小脑代谢低下，提示 MSA。
本病例展示了在伴有 OH 的老年患者中使用连续 BP 记录来诊断 NHT 的方法。它说明了 18-FDG PET 脑 CT 扫描在明确 AF 性质方面的有用性。该病例还说明了管理 OH 和 NHT 组合的困难。
