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Supine hypertension in Parkinson’s disease and multiple system atrophy

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Abstract

Objective

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).

Methods

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.

Results

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.

Interpretation

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.

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Study funding

This was an academic study; no external financial support was allotted.

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Authors and Affiliations

  1. Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria

    Alessandra Fanciulli, Jean Pierre Ndayisaba, Roberta Granata, Susanne Duerr, Werner Poewe & Gregor K. Wenning

  2. Department of Neuroscience, Mental Health and Sensory Organs, “Sapienza” University of Rome, Rome, Italy

    Alessandra Fanciulli & Francesco E. Pontieri

  3. Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria

    Georg Göbel

  4. Department of Heart and Great Vessels “A. Reale”, “Sapienza” University of Rome, Rome, Italy

    Stefano Strano

  5. Neurology and Stroke Unit, Department of Neurosciences, Azienda Ospedaliero, Universitaria Santa Maria, Terni, Italy

    Carlo Colosimo

  6. I.R.C.C.S Santa Lucia Foundation, Rome, Italy

    Francesco E. Pontieri

Authors
  1. Alessandra Fanciulli
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  2. Georg Göbel
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  3. Jean Pierre Ndayisaba
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  4. Roberta Granata
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  5. Susanne Duerr
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  6. Stefano Strano
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  7. Carlo Colosimo
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  8. Werner Poewe
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  9. Francesco E. Pontieri
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  10. Gregor K. Wenning
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Corresponding author

Correspondence to Alessandra Fanciulli.

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Competing interests

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.

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The study received approval by the local ethical committees and was performed according to the Declaration of Helsinki.

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Fanciulli, A., Göbel, G., Ndayisaba, J.P. et al. Supine hypertension in Parkinson’s disease and multiple system atrophy. Clin Auton Res 26, 97–105 (2016). https://doi.org/10.1007/s10286-015-0336-4

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  • DOI: https://doi.org/10.1007/s10286-015-0336-4

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