Heisler Jillian M, Toledo-Atucha Jon, Lin Chih-Chun, Patel Harsh N, Ondo William G
Work done while at Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, USA.
Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
Clin Park Relat Disord. 2024 Jul 9;11:100262. doi: 10.1016/j.prdoa.2024.100262. eCollection 2024.
Both measured orthostatic hypotension and symptomatic orthostasis are common in PD but their relationship is unclear.
We aim to determine clinical predictors of both measured orthostatic hypotension and reported symptomatic orthostasis in PD, including the impact of "on"/"off" status and seasons, and to determine the correlation between measured OH and subjective orthostasis.
We analyzed BP readings, demographic and disease state predictors for both 1. Measured blood pressure OH criteria and 2. The subjective report of orthostatic symptoms, using logistic regression analyses from an initial "on" motor state clinical visit in all PD patient visits. We then correlated subjective orthostasis symptoms with BP measurements. We also compared intra-subject BP measures in PD patients seen in both "on" and "off" states, and when seen "on" in both summer and winter.
723 consecutive visits over 2 years identified 250 unique PD individuals. Subjective orthostasis was reported by 44 % and "on" measured OH (>20 drop in SBP or 10 DBP upon standing) was seen in 30 %. Measured OH did not significantly correlate with any assessed clinical feature or specific medicine. Subjective orthostasis correlated most with older age, dementia, and L-dopa use. Subjective orthostasis correlated equally with absolute lower measured standing SBP and the drop in SBP from sitting to standing. Compared to the "off" state, "on" state showed lower sitting and standing SBP, more than DBP, but no significant change in BP drop upon standing. Seasons did not impact measured BP.
Both OH and symptomatic orthostasis are common. Dopaminergic medications did not cause traditionally defined OH but lowered all SBP (sitting and standing) and thus reduced pulse pressure, possibly by increasing arteriole compliance simply by reducing motor tone, as this BP-lowering effect may be specific to Parkinsonism.
测量性直立性低血压和症状性直立不耐受在帕金森病（PD）中均很常见，但它们之间的关系尚不清楚。
我们旨在确定PD患者中测量性直立性低血压和报告的症状性直立不耐受的临床预测因素，包括“开”/“关”状态和季节的影响，并确定测量的直立性低血压（OH）与主观直立不耐受之间的相关性。
我们分析了血压读数、人口统计学和疾病状态预测因素，用于1. 测量血压的OH标准和2. 直立症状的主观报告，使用来自所有PD患者就诊时初始“开”运动状态临床访视的逻辑回归分析。然后我们将主观直立不耐受症状与血压测量值进行关联。我们还比较了在“开”和“关”状态下以及在夏季和冬季“开”状态下就诊的PD患者的个体内血压测量值。
2年期间连续723次就诊确定了250名独特的PD个体。44%的患者报告有主观直立不耐受，30%的患者出现“开”状态下测量的OH（站立时收缩压下降>20或舒张压下降10）。测量的OH与任何评估的临床特征或特定药物均无显著相关性。主观直立不耐受与年龄较大、痴呆和使用左旋多巴的相关性最大。主观直立不耐受与测量的站立时绝对较低收缩压以及从坐位到站立时收缩压的下降具有同等相关性。与“关”状态相比，“开”状态下坐位和站立时收缩压较低，舒张压降低更明显，但站立时血压下降无显著变化。季节对测量血压无影响。
OH和症状性直立不耐受均很常见。多巴胺能药物并未导致传统定义的OH，但降低了所有收缩压（坐位和站立时），从而降低了脉压，可能是通过简单地降低运动张力来增加小动脉顺应性，因为这种降压作用可能是帕金森病特有的。
