Plaschke M, Trenkwalder P, Dahlheim H, Lechner C, Trenkwalder C
Max Planck Institute of Psychiatry, Department of Neurology and Clinical Neurophysiology, Munich, Germany.
J Hypertens. 1998 Oct;16(10):1433-41. doi: 10.1097/00004872-199816100-00006.
To investigate the 24 h blood pressure profile in patients with Parkinson's disease with intact autonomic function or with autonomic failure and patients with multiple system atrophy (MSA), and to assess whether these patients exhibit posture-related variations in blood pressure.
We studied 24 patients with Parkinson's disease (11 with autonomic failure) and 13 patients with MSA (all with autonomic failure). Autonomic failure was determined by autonomic tests. An oscillometric recorder was used for ambulatory blood pressure monitoring. Tilt-table tests were performed with a head-up tilt position of 60 degrees.
An alteration in the normal 24 h blood pressure profile was observed in 82% of Parkinson's disease patients with autonomic failure and in 85% of those with multiple system atrophy, but not in the patients with intact autonomic function. Head-up tilt tests revealed a significantly higher supine blood pressure in Parkinson's disease patients with autonomic failure and in those with MSA than in Parkinson's disease patients with intact autonomic function. Tilting resulted in a marked fall in blood pressure in patients with MSA; in Parkinson's disease patients with autonomic failure, the fall was comparatively slighter.
We conclude that autonomic failure contributes to the alterations in the day-night blood pressure profile that may possibly be ascribed to postural dysregulation of blood pressure. We hypothesize that nocturnal hypertension is a risk factor in the development of additional cerebrovascular disease in patients with Parkinson's disease or MSA who are affected by autonomic failure.
研究自主神经功能正常或存在自主神经功能衰竭的帕金森病患者以及多系统萎缩（MSA）患者的24小时血压变化情况，并评估这些患者是否存在与体位相关的血压变化。
我们研究了24例帕金森病患者（11例存在自主神经功能衰竭）和13例MSA患者（均存在自主神经功能衰竭）。通过自主神经测试确定自主神经功能衰竭情况。使用示波记录仪进行动态血压监测。进行头高位倾斜60度的倾斜试验。
82%的自主神经功能衰竭帕金森病患者和85%的多系统萎缩患者出现正常24小时血压变化模式的改变，而自主神经功能正常的患者未出现这种改变。头高位倾斜试验显示，自主神经功能衰竭的帕金森病患者和MSA患者的仰卧位血压显著高于自主神经功能正常的帕金森病患者。倾斜导致MSA患者血压明显下降；自主神经功能衰竭的帕金森病患者血压下降相对较轻。
我们得出结论，自主神经功能衰竭导致昼夜血压变化模式改变，这可能归因于血压的体位调节异常。我们推测夜间高血压是自主神经功能衰竭的帕金森病或MSA患者发生额外脑血管疾病的危险因素。
