Orthostatic hypotension (OH) is a common non-motor sign of Parkinson’s disease (PD). Several epidemiological studies have estimated the association between OH and PD with controversial results. Here, a meta-analysis was conducted to evaluate the association between them.
PubMed, Embase, Web of Science, CNKI (Chinese National Knowledge Infrastructure), VIP (Database of Chinese Scientific and Technical Periodicals), and Wanfang databases were searched for eligible publications from October 2003 to December 2017. Prevalence numbers from studies were pooled using a non-linear random-effects meta-analysis. Random effect model was used to calculate the pooled odds ratio (OR) with 95% confidence intervals (CIs) from individual studies. Publication bias was estimated by Egger’s test, Begg’s test, and the funnel plot.
Nineteen studies involving 1620 PD patients and 898 healthy controls were included in this meta-analysis. The pooled estimate of the prevalence of OH in PD was 27.7% compared with 7.9% of that in control. The pooled OR of OH with PD was 4.343 (95% CI 3.323–5.676) with a low heterogeneity (I2 = 12.5%, Pheterogeneity = 0.301).
In the present meta-analysis, the pooled OR of OH with PD was 4.343 (95% CI 3.323–5.676) with a low heterogeneity, which showed a significant association between OH and increased risk of PD.
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Jiang H, Song N, Jiao Q, Shi L, Du X (2019) Iron pathophysiology in Parkinson diseases. Adv Exp Med Biol 1173:45–66
Elkouzi A, Vedam-Mai V, Eisinger RS, Okun MS (2019) Emerging therapies in Parkinson disease - repurposed drugs and new approaches. Nat Rev Neurol 15:204–223
Buob A, Winter H, Kindermann M, Becker G, Moller JC, Oertel WH et al (2010) Parasympathetic but not sympathetic cardiac dysfunction at early stages of Parkinson’s disease. Clin Res Cardiol 99:701–706
Wang W, Song N, Jia F, Tang T, Bao W, Zuo C et al (2018) Genomic DNA levels of mutant alpha-synuclein correlate with non-motor symptoms in an A53T Parkinson’s disease mouse model. Neurochem Int 114:71–79
Chaudhuri KR, Healy DG, Schapira AH (2006) Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 5:235–245
(1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology 46: 1470
Shaw BH, Claydon VE (2014) The relationship between orthostatic hypotension and falling in older adults. Clin Auton Res 24:3–13
Cersosimo MG, Benarroch EE (2012) Autonomic involvement in Parkinson’s disease: pathology, pathophysiology, clinical features and possible peripheral biomarkers. J Neurol Sci 313:57–63
Papapetropoulos S, Paschalis C, Athanassiadou A, Papadimitriou A, Ellul J, Polymeropoulos MH et al (2001) Clinical phenotype in patients with alpha-synuclein Parkinson’s disease living in Greece in comparison with patients with sporadic Parkinson’s disease. J Neurol Neurosurg Psychiatry 70:662–665
Goldstein DS, Holmes C, Bentho O, Sato T, Moak J, Sharabi Y et al (2008) Biomarkers to detect central dopamine deficiency and distinguish Parkinson disease from multiple system atrophy. Parkinsonism Relat Disord 14:600–607
Velseboer DC, de Haan RJ, Wieling W, Goldstein DS, de Bie RM (2011) Prevalence of orthostatic hypotension in Parkinson’s disease: a systematic review and meta-analysis. Parkinsonism Relat Disord 17:724–729
Song F, Gilbody S (1998) Bias in meta-analysis detected by a simple, graphical test. Increase in studies of publication bias coincided with increasing use of meta-analysis. Bmj 316:471
Bonuccelli U, Lucetti C, Del Dotto P, Ceravolo R, Gambaccini G, Bernardini S et al (2003) Orthostatic hypotension in de novo Parkinson disease. Arch Neurol 60:1400–1404
Matsui H, Nishinaka K, Oda M, Komatsu K, Kubori T, Udaka F (2006) Does cardiac metaiodobenzylguanidine (MIBG) uptake in Parkinson’s disease correlate with major autonomic symptoms? Parkinsonism Relat Disord 12:284–288
Nataraj A, Rajput AH (2005) Parkinson’s disease, stroke, and related epidemiology. Mov Disord 20:1476–1480
Idiaquez J, Benarroch EE, Rosales H, Milla P, Rios L (2007) Autonomic and cognitive dysfunction in Parkinson’s disease. Clin Auton Res 17:93–98
Adhiyaman V, Hobson P, Meara RJ (2008) Central and peripheral autonomic integrity in Parkinson’s disease. Age Ageing 37:578–581
Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C et al (2009) Valsalva manoeuvre in patients with different Parkinsonian disorders. J Neural Transm (Vienna) 116:875–880
Wang W, Zhang QH, Zhao HQ (2012) Variability of blood pressure and heart rate in patients with Parkinson’s disease in Thulesius test. Chin J Hemorh:582–585
Hu X, Li ZH, Liu WG, Yan FL (2013) Related risk factors of orthostatic hypotension and postprandial hypotension of Parkinson disease. J Clin Neurol:260–263
Asahina M, Low DA, Mathias CJ, Fujinuma Y, Katagiri A, Yamanaka Y, Shimada J, Poudel A, Kuwabara S (2013) Skin temperature of the hand in multiple system atrophy and Parkinson’s disease. Parkinsonism Relat Disord 19:560–562
Nakamura T, Hirayama M, Hara T, Mizutani Y, Suzuki J, Watanabe H, Sobue G (2014) Role of cardiac sympathetic nerves in preventing orthostatic hypotension in Parkinson’s disease. Parkinsonism Relat Disord 20:409–414
Baschieri F, Calandra-Buonaura G, Doria A, Mastrolilli F, Palareti A, Barletta G, Solieri L, Guaraldi P, Martinelli P, Cortelli P (2015) Cardiovascular autonomic testing performed with a new integrated instrumental approach is useful in differentiating MSA-P from PD at an early stage. Parkinsonism Relat Disord 21:477–482
Sprenger FS, Seppi K, Djamshidian A, Reiter E, Nocker M, Mair K, Göbel G, Poewe W (2015) Nonmotor symptoms in subjects without evidence of dopaminergic deficits. Mov Disord 30:976–981
Wang Q (2015) The studies of autonomic dysfunctions in Parkinson’s patients
Kim JS, Lee SH, Oh YS, Park JW, An JY, Park SK, Han SR, Lee KS (2016) Cardiovascular autonomic dysfunction in mild and advanced Parkinson’s disease. J Mov Disord 9:97–103
Kang SJ, Ahn JY, Kim JS, Cho JW, Kim JY, Choi YY, Kim HT (2016) 24-hour ambulatory blood pressure monitoring in SWEDDs patients with parkinsonism. Can J Neurol Sci 43:390–397
Hatsuta H, Takao M, Nakano Y, Nogami A, Uchino A, Sumikura H et al (2016) Reduction of small fibers of thoracic ventral roots and neurons of Intermediolateral nucleus in Parkinson disease and dementia with Lewy bodies. J Park Dis 6:325–334
Campolo J, De Maria R, Cozzi L, Parolini M, Bernardi S, Proserpio P et al (2016) Antioxidant and inflammatory biomarkers for the identification of prodromal Parkinson’s disease. J Neurol Sci 370:167–172
Yalcin A, Atmis V, Cengiz OK, Cinar E, Aras S, Varli M, Atli T (2016) Evaluation of cardiac autonomic functions in older Parkinson’s disease patients: a cross-sectional study. Aging Dis 7:28–35
Zhao R, Tian T, Ji YF, Hu WT, Liu X, Yang Q et al (2017) Clinical analysis of the prevalence of orthostatic hypotension and related risk factors in 189 patients with Parkinson’s disease. J Apoplexy Nervous Disease:242–246
Jiang H, Wang J, Rogers J, Xie J (2017) Brain Iron metabolism dysfunction in Parkinson’s disease. Mol Neurobiol 54:3078–3101
Sulzer D, Edwards RH (2019) The physiological role of alpha-synuclein and its relationship to Parkinson’s disease. J Neurochem 150:475–486
Zhang Z, Shi L, Du X, Jiao Q, Jiang H (2017) Acute action of rotenone on excitability of catecholaminergic neurons in rostral ventrolateral medulla. Brain Res Bull 134:151–161
Wang Y, Chen AQ, Xue Y, Liu MF, Liu C, Liu YH, Pan YP, Diao HL, Chen L (2019) Orexins alleviate motor deficits via increasing firing activity of pallidal neurons in a mouse model of Parkinson’s disease. Am J Physiol Cell Physiol 317:C800–C812
Sharabi Y, Goldstein DS (2011) Mechanisms of orthostatic hypotension and supine hypertension in Parkinson disease. J Neurol Sci 310:123–128
Handa SP, Wong J, Wolf HK (1995) The relationship of plasma norepinephrine levels and aortic distensibility in elderly with isolated systolic hypertension. Am J Hypertens 8:422–425
Wullner U, Schmitz-Hubsch T, Antony G, Fimmers R, Spottke A, Oertel WH et al (2007) Autonomic dysfunction in 3414 Parkinson’s disease patients enrolled in the German Network on Parkinson’s disease (KNP e.V.): the effect of ageing. Eur J Neurol 14:1405–1408
Perez-Lloret S, Rey MV, Fabre N, Ory F, Spampinato U, Senard JM, Pavy-le Traon A, Montastruc JL, Rascol O (2012) Factors related to orthostatic hypotension in Parkinson’s disease. Parkinsonism Relat Disord 18:501–505
Perlmuter LC, Sarda G, Casavant V, Mosnaim AD (2013) A review of the etiology, associated comorbidities, and treatment of orthostatic hypotension. Am J Ther 20:279–291
Jamnadas-Khoda J, Koshy S, Mathias CJ, Muthane UB, Ragothaman M, Dodaballapur SK (2009) Are current recommendations to diagnose orthostatic hypotension in Parkinson’s disease satisfactory? Mov Disord 24:1747–1751
Ziemssen T, Reichmann H (2010) Cardiovascular autonomic dysfunction in Parkinson’s disease. J Neurol Sci 289:74–80
Fereshtehnejad SM, Lokk J (2014) Orthostatic hypotension in patients with Parkinson’s disease and atypical parkinsonism. Parkinsons Dis 2014:475854
This work financially supported by the National Foundation of Natural Science of China (31771110, 31701020), Shandong Province Natural Science Foundation (ZR2019ZD31), the National Key Research and Development Program of China (2016YFC1306501), the Key Research and Development Program of Shandong Province (2018GSF118042), and Taishan Scholars Construction Project and Innovative Research Team of High-Level Local Universities in Shanghai.
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Mu, F., Jiao, Q., Du, X. et al. Association of orthostatic hypotension with Parkinson’s disease: a meta-analysis. Neurol Sci (2020). https://doi.org/10.1007/s10072-020-04277-w
- Parkinson’s disease
- Orthostatic hypotension
- Odds ratio