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Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson’s disease

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Abstract

Purpose

Neurogenic orthostatic hypotension (nOH) is a frequent nonmotor feature of Parkinson’s disease (PD), associated with adverse outcomes. Recently, 24-h ambulatory blood pressure monitoring (ABPM) showed good accuracy in diagnosing nOH. This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to the well-defined prognostic role of bedside nOH.

Methods

Patients with PD who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, and mortality, during an up-to-10-year follow-up. Significant ABPM-hypotensive episodes were identified when greater than or equal to two episodes of systolic BP drop ≥ 15 mmHg (compared with the average 24 h) were recorded during the awakening-to-lunch period.

Results

A total of 99 patients (74% male, age 64.0 ± 10.1 years, and PD duration 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH.

On Kaplan–Meier analysis, patients with ABPM-hypotensive episodes showed earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and shorter survival (8.0 versus 9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and Hoehn and Yahr stage) a significant association was confirmed between ABPM-hypotensive episodes and falls [odds ratio (OR) 3.626; p = 0.001), hospitalizations (OR 2.016; p = 0.038), and dementia (OR 2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR 1.908; p = 0.048).

Conclusions

The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.

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Data availability

The data that support the findings of this study are available from the corresponding author, Fabrizio Vallelonga, upon reasonable request.

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Author notes

  1. Joint-first authors: Fabrizio Vallelonga and Matteo Valente.

  2. Joint-last authors: Simona Maule and Alberto Romagnolo.

Authors and Affiliations

  1. Division of Internal Medicine, Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142, Km 3,95, Candiolo, 10060, Turin, Italy

    Fabrizio Vallelonga & Alberto Milan

  2. Department of Medical Science, University of Turin, Turin, Italy

    Fabrizio Vallelonga & Alberto Milan

  3. Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy

    Fabrizio Vallelonga, Matteo Valente, Valeria Milazzo, Cristina Di Stefano, Gabriele Sobrero, Marta Giudici, Alberto Milan, Franco Veglio & Simona Maule

  4. Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy

    Marta Maria Tangari, Anna Covolo, Leonardo Lopiano & Alberto Romagnolo

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  1. Fabrizio Vallelonga
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  2. Matteo Valente
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Contributions

(1) Research project: A. Conception: F.Va., S.M., and A.R., B. Organization: F.Va., M.V., S.M., A.R., F.Ve., and L.L., C. Execution: M.V., M.M.T., A.C., G.S., V.M., C.D., and M.G. (2) Statistical analysis: A. Design: F.Va., A.R., and A.M., B. Execution: F.Va. and A.R., C. Review and critique: all authors. (3) Manuscript: A. Writing of the first draft: F.Va., M.V. and A.R. B. Review and critique: all authors.

Corresponding author

Correspondence to Fabrizio Vallelonga.

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Conflict of interest

F.Va., M.V., M.M.T., A.C., V.M., C.D., G.S., M.G., F.Ve., L.L., and S.M. report no conflict of interest. AR received grant support and speaker honoraria from Abbvie, speaker honoraria from Chiesi Farmaceutici, and travel grants from Lusofarmaco, ChiesiFarmaceutici, Medtronic, and UCB Pharma. A.M. received supported from the NIH (KL2 TR001426), speaker honoraria from CSL Behring, Abbvie, Abbott, Theravance, and Cynapsus Therapeutics; he also received grant support from Lundbeck and Abbvie.

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Vallelonga, F., Valente, M., Tangari, M.M. et al. Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson’s disease. Clin Auton Res 34, 281–291 (2024). https://doi.org/10.1007/s10286-024-01030-7

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