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Autonomic Dysfunction: How to Identify and When to Treat?

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Abstract

Cardiovascular autonomic dysfunction (AD) is a particular condition that can be detected by means of ambulatory blood pressure monitoring (ABPM). ABPM is helpful to identify some specific characteristics of haemodynamic AD, including non-dipping/reverse-dipping pattern, orthostatic and post-prandial hypotension and elevated blood pressure variability. These characteristics may be misdiagnosed with traditional, clinic blood pressure measurements. AD is relatively common in the real world. By analysing about 1000 recordings in a Cardiology unit, AD was found in 6.8 % of the exams. Several diseases may be the underlying causes of AD. In our sample half of the subjects were diabetic (54.4 %), 17.7 % were patients with alpha-synucleinopathy (Parkinson disease or multiple system atrophy), and 27.9 % had other underlying causes of AD including chronic kidney disease, α-lytic drug assumption and AD from unknown causes. According to the different aetiology, different clinical characteristics can be found, in particular in diabetics these peculiar aspects are less pronounced compared to the other subgroups. These characteristics have been found to be predictors of cardiovascular events, organ damage, and mortality. For these reasons, early identification of these behaviours is important, in order to better define patient’s cardiovascular risk profile. As regard treatment of AD, several drugs have been tested, however none of this showed efficacy in all kinds of patients. Another open aspect is “safe” reference values for supine hypertension.

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Authors and Affiliations

  1. Cardiology Unit, Town Hospital of Camposampiero, via Pietro Cosma 2, Camposampiero, Italy

    Francesca Saladini & Attilio Di Marco

  2. Vascular Medicine, Department of Medicine, University of Padova, via Giustiniani, 2, 35128, Padua, Italy

    Francesca Saladini & Paolo Palatini

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  1. Francesca Saladini
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  2. Attilio Di Marco
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  3. Paolo Palatini
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Correspondence to Francesca Saladini.

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This paper is part of my oral lecture at the XXXII National Meeting of the Italian Society of Hypertension, at the Symposium: Ambulatory blood pressure monitoring in the clinical management of hypertension: open aspect.

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Saladini, F., Di Marco, A. & Palatini, P. Autonomic Dysfunction: How to Identify and When to Treat?. High Blood Press Cardiovasc Prev 23, 237–243 (2016). https://doi.org/10.1007/s40292-016-0162-3

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