Supine hypertension in Parkinson’s disease and multiple system atrophy
Supine hypertension (SH) is a feature of cardiovascular autonomic failure that often accompanies orthostatic hypotension and may represent a negative prognostic factor in parkinsonian syndromes. Here we investigated the frequency rate as well as the clinical and tilt test correlates of SH in Parkinson’s disease (PD) and multiple system atrophy (MSA).
197 PD (33 demented) and 78 MSA (24 MSA-Cerebellar, 54 MSA-Parkinsonian) patients who had undergone a tilt test examination were retrospectively included. Clinical-demographic characteristics were collected from clinical records at the time of the tilt test examination.
SH (>140 mmHg systolic, >90 mmHg diastolic) occurred in 34 % of PD patients (n = 66, mild in 71 % of patients, moderate in 27 %, severe in 2 %) and 37 % of MSA ones (n = 29, mild in 55 % of patients, moderate in 17 %, severe in 28 %). No difference was observed in SH frequency between demented versus gender-, age- and disease duration-matched non-demented PD patients, or between patients with the parkinsonian (MSA-P) versus the cerebellar (MSA-C) variant of MSA. In PD, SH was associated with presence of cardiovascular comorbidities (p = 0.002) and greater systolic (p = 0.007) and diastolic (p = 0.002) orthostatic blood pressure fall. Orthostatic hypotension (p = 0.002), and to a lesser degree, lower daily dopaminergic intake (p = 0.01) and use of anti-hypertensive medications (p = 0.04) were associated with SH in MSA.
One-third of PD and MSA patients suffer from mild to severe SH, independently of age, disease duration or stage. In PD, cardiovascular comorbidities significantly contribute to the development of SH, while in MSA, SH appears to reflect cardiovascular autonomic failure.
KeywordsParkinson’s disease Parkinson’s disease with dementia Multiple system atrophy Orthostatic hypotension Supine hypertension
This was an academic study; no external financial support was allotted.
Compliance with ethical standards
A Fanciulli: reports no competing interests related to this article. Dr. Fanciulli received royalties from Springer Verlag and from the Massachusetts Medical Society. G. Göbel: reports no competing interests. J. P. Ndayisaba: reports no competing interests. R. Granata: reports no competing interests. S. Duerr: reports no competing interests. S. Strano: reports no competing interests. C. Colosimo: reports no competing interests related to this article. Prof Colosimo served as consultant for Ipsen, Merz and Lundbeck. W. Poewe: reports no competing interests related to this article. Unrelated to this research he reports personal fees from AbbVie, Allergan, AstraZeneca, BIAL; Boehringer-Ingelheim, Boston Scientific, GlaxoSmithKline, Ipsen, Lundbeck, Medtronic, MSD, Merck-Serono, Merz Pharmaceuticals, Novartis, Orion Pharma, Teva, UCB and Zambon (consultancies and lecture fees in relation to clinical drug development programmes for PD). Royalties: Thieme, Wiley Blackwell, Oxford University Press and Cambridge University Press. F. E. Pontieri: reports no competing interests. G.K.Wenning: reports no competing interests related to this article. Prof. Wenning served as consultant for Astra Zeneca, received lecture fees from Astra, Lundbeck, UCB and Abbvie and royalties from Cambridge University Press, Springer Verlag and from the Massachusetts Medical Society.
The study received approval by the local ethical committees and was performed according to the Declaration of Helsinki.
For this type of study informed consent is not required.
- 5.Wenning GK et al (2013) The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol 12(3):264–274Google Scholar
- 6.Low PA et al (2015) Natural history of multiple system atrophy in the USA: a prospective cohort study. Lancet Neurol 14(7):710–719Google Scholar
- 7.Fanciulli A et al (2014) Detecting nocturnal hypertension in Parkinson’s disease and multiple system atrophy: proposal of a decision-support algorithm. J NeurolGoogle Scholar
- 19.Pavy-Le Traon A et al (2015) New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study. J Neurol Neurosurg Psychiatry (e-pub ahead of print)Google Scholar
- 26.Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Stat Soc B 57(1):289–300Google Scholar