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

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.

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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

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Conflicts of interest

Alessandra Fanciulli: the author declares no conflict of interest. Stefano Strano: the author declares no conflict of interest. Jean Pierre Ndayisaba: the author declares no conflict of interest. Georg Goebel: the author declares no conflict of interest. Laura Gioffrè: the author declares no conflict of interest. Massimiliano Rizzo: the author declares no conflict of interest. Carlo Colosimo: the author declares no conflict of interest. Carlo Caltagirone: the author declares no conflict of interest. Werner Poewe: has received consultancy and lecture fees from Abbott, Astra Zeneca, Teva, Novartis, GSK, Boehringer-Ingelheim, UCB, Orion Pharma, Merck Serono and Merz Pharmaceuticals in relation to clinical drug development programmes for PD. Gregor K. Wenning: the author declares no conflict of interest. Francesco E. Pontieri: the author declares no conflict of interest.

Author information

Correspondence to Gregor K. Wenning.

Additional information

G. K. Wenning and F. E. Pontieri contributed equally to the work.

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Fanciulli, A., Strano, S., Ndayisaba, J.P. et al. Detecting nocturnal hypertension in Parkinson’s disease and multiple system atrophy: proposal of a decision-support algorithm. J Neurol 261, 1291–1299 (2014). https://doi.org/10.1007/s00415-014-7339-2

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Keywords

  • Parkinson’s disease
  • Multiple system atrophy
  • Nocturnal hypertension
  • Orthostatic hypotension
  • Valsalva manoeuvre