Journal of Neurology

, Volume 261, Issue 7, pp 1291–1299

Detecting nocturnal hypertension in Parkinson’s disease and multiple system atrophy: proposal of a decision-support algorithm

  • Alessandra Fanciulli
  • Stefano Strano
  • Jean Pierre Ndayisaba
  • Georg Goebel
  • Laura Gioffrè
  • Massimiliano Rizzo
  • Carlo Colosimo
  • Carlo Caltagirone
  • Werner Poewe
  • Gregor K. Wenning
  • Francesco E. Pontieri
Original Communication

DOI: 10.1007/s00415-014-7339-2

Cite this article as:
Fanciulli, A., Strano, S., Ndayisaba, J.P. et al. J Neurol (2014) 261: 1291. doi:10.1007/s00415-014-7339-2

Abstract

A pathological nocturnal blood pressure (BP) profile, either non-dipping or reverse dipping, occurs in more than 50 % of subjects diagnosed with multiple system atrophy (MSA) or Parkinson’s disease (PD). This may play a negative prognostic role in α-synucleinopathies, but, being mostly asymptomatic, remains largely underdiagnosed. In this proof-of-concept study, we aimed at developing a decision-support algorithm to predict pathological nocturnal BP profiles during a standard tilt-table examination in PD and MSA. Sixteen MSA and 16 PD patients underwent standard tilt-table examination and 24-h ambulatory BP monitoring (24-h ABPM). Clinical and tilt test differences between patients with a normal and a pathological nocturnal BP profile at 24-h ABPM were assessed, and a decision-support algorithm was developed accordingly. 75 % of MSA and 31 % of PD patients showed a pathological nocturnal BP profile. This was associated with more pronounced orthostatic BP drop (p = 0.03), joint occurrence of orthostatic hypotension and supine hypertension (p = 0.046), and lack of BP overshoot in the late phase II (II_L, p = 0.002) and in the phase IV (p = 0.007) of the Valsalva manoeuvre. Combined ∆BP ≤0.5 mmHg in the II_L and ≤−7 mmHg in the IV phase of Valsalva manoeuvre correctly predicted a pathological nocturnal BP profile with 87.5 % sensitivity and 85.7 % specificity. Pathological nocturnal BP profiles are associated with evidence of cardiovascular noradrenergic failure in PD and MSA. The Valsalva manoeuvre is routinely performed during standard tilt-table examinations. We propose the naked-eye evaluation of Valsalva phase II_L and phase IV BP behaviour as time-sparing screening tool for pathological nocturnal BP profiles in PD and MSA.

Keywords

Parkinson’s diseaseMultiple system atrophyNocturnal hypertensionOrthostatic hypotensionValsalva manoeuvre

Abbreviations

24-h ABPM

24-h ambulatory blood pressure monitoring

II_E

Early phase II of the Valsalva manoeuvre

II_L

Late phase II of the Valsalva manoeuvre

BP

Blood pressure

HR

Heart rate

OH

Orthostatic hypotension

PD

Parkinson’s disease

MSA

Multiple system atrophy

SH

Supine hypertension

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Alessandra Fanciulli
    • 1
    • 2
  • Stefano Strano
    • 3
  • Jean Pierre Ndayisaba
    • 2
  • Georg Goebel
    • 4
  • Laura Gioffrè
    • 3
  • Massimiliano Rizzo
    • 3
  • Carlo Colosimo
    • 5
  • Carlo Caltagirone
    • 6
  • Werner Poewe
    • 2
  • Gregor K. Wenning
    • 2
  • Francesco E. Pontieri
    • 1
    • 6
  1. 1.Department of Neuroscience, Mental Health and Sensory Organs“Sapienza” University of RomeRomeItaly
  2. 2.Universitätsklinik für NeurologieMedizinische Universität InnsbruckInnsbruckAustria
  3. 3.Department of Heart and Great Vessels “A. Reale”“Sapienza” University of RomeRomeItaly
  4. 4.Department of Medical Statistics, Informatics and Health EconomicsMedizinische Universität InnsbruckInnsbruckAustria
  5. 5.Department of Neurology and Psychiatry“Sapienza” University of RomeRomeItaly
  6. 6.I.R.C.C.S Santa Lucia FoundationRomeItaly