Kapoor Sunil, Saluja Alvee, Margekar Shubha Laxmi, Agarwal Mayank, Mondal Sunita, Dhamija Rajinder K
Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
Ann Indian Acad Neurol. 2023 Jan-Feb;26(1):33-38. doi: 10.4103/aian.aian_476_22. Epub 2022 Nov 4.
Natural history and disease progression in patients with Idiopathic Parkinson's Disease (PD) is quite heterogeneous. Autonomic dysfunction occurs commonly among Idiopathic PD patients. Heart rate variability and ambulatory blood pressure monitoring are used to assess cardiac autonomic dysfunction. The prevalence and magnitude of supine hypertension in Indian PD patients has not been studied to date. The present study aimed to record cardiovascular autonomic functions and supine hypertension in PD patients and to correlate them with the age of onset, duration and severity of the disease, and non-motor symptom burden.
The cross-sectional study involved 60 PD patients. Webster rating scale was used to determine the disease severity. Non-motor symptom burden was assessed using the Non-Motor Symptom Scale (NMSS). Ambulatory blood pressure monitoring and heart rate variability parameters determined cardiac autonomic function. Supine hypertension was defined as Systolic Blood Pressure (SBP) ≥150 mmHg and/or DBP ≥90 mmHg. Less than 10% decrease or even increase in blood pressure during the night were classified as non-dippers. Pearson coefficient was used appropriately to establish correlation. ≤ 0.05 was considered significant.
Age of onset was 61.2 ± 8.7 years and duration of disease was 1.7 ± 1.1 years. Mean Webster and non-motor symptom scores were 12.7 ± 4.4 and 15.5 ± 8.0, respectively. About 50 patients (83%) were non-dipper, while 32 (53%) had supine hypertension. Low Frequency oscillations (LF) (r = 0.28), High Frequency oscillations (HF) (r = 0.29), Standard Deviation NN intervals (SDNN) (0.26), and Root Mean Squared Successive Differences of NN intervals (RMSSD) (r = 0.28) correlated significantly with non-motor symptoms scale. LF (r = -0.39), HF (r = -0.43), SDNN (-0.40), RMSSD (r = -0.41), NN50 (r = -0.38), PNN50 (r = -0.42), mean SBP (r = 0.26), and mean DBP (r = 0.33) correlated significantly with disease duration. PNN50 (r = -0.255), mean SBP (r = -0.29), and mean DBP (r = -0.27) correlated significantly with age at onset.
Awareness regarding neurogenic supine hypertension is needed as it occurs commonly among Indian PD patients. Heart rate variability (HRV) parameters and ambulatory blood pressure are of significant help in the detection of early cardiovascular autonomic dysfunction and correlate significantly with disease duration and non-motor symptom burden among PD patients.
特发性帕金森病（PD）患者的自然病史和疾病进展具有很大的异质性。自主神经功能障碍在特发性PD患者中很常见。心率变异性和动态血压监测用于评估心脏自主神经功能障碍。迄今为止，尚未对印度PD患者中仰卧位高血压的患病率和严重程度进行研究。本研究旨在记录PD患者的心血管自主神经功能和仰卧位高血压，并将它们与发病年龄、疾病持续时间和严重程度以及非运动症状负担相关联。
这项横断面研究纳入了60例PD患者。使用韦伯斯特评分量表确定疾病严重程度。使用非运动症状量表（NMSS）评估非运动症状负担。动态血压监测和心率变异性参数确定心脏自主神经功能。仰卧位高血压定义为收缩压（SBP）≥150 mmHg和/或舒张压（DBP）≥90 mmHg。夜间血压下降小于10%甚至升高被归类为非勺型血压。适当使用皮尔逊系数建立相关性。≤0.05被认为具有显著性。
发病年龄为61.2±8.7岁，疾病持续时间为1.7±1.1年。韦伯斯特评分和非运动症状评分的平均值分别为12.7±4.4和15.5±8.0。约50例患者（83%）为非勺型血压，而32例（53%）有仰卧位高血压。低频振荡（LF）（r = 0.28）、高频振荡（HF）（r = 0.29）、标准偏差NN间期（SDNN）（0.26）和NN间期的均方根连续差值（RMSSD）（r = 0.28）与非运动症状量表显著相关。LF（r = -0.39）、HF（r = -0.43）、SDNN（-0.40）、RMSSD（r = -0.41）、NN50（r = -0.38）、PNN50（r = -0.42）、平均SBP（r = 0.26）和平均DBP（r = 0.33）与疾病持续时间显著相关。PNN50（r = -0.255）、平均SBP（r = -0.29）和平均DBP（r = -0.27）与发病年龄显著相关。
由于神经源性仰卧位高血压在印度PD患者中很常见，因此需要提高对此的认识。心率变异性（HRV）参数和动态血压在检测早期心血管自主神经功能障碍方面有很大帮助，并且与PD患者的疾病持续时间和非运动症状负担显著相关。
