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Cited by 103Cardiovascular Syncope and Autonomic DisordersParkinson's Disease Mechanisms and TreatmentsHeart Rate Variability and Autonomic Control

Orthostatic hypotension in de novo Parkinson disease

Bonuccelli, Ubaldo, Lucetti, Claudio, Del Dotto, Paolo, Ceravolo, Roberto, Gambaccini, Gianna, Bernardini, Silvia, Rossi, Giuseppe, Piaggesi, Alberto·2003·Archives of Neurology
DOI 10.1001/archneur.60.10.1400
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Abstract

BACKGROUND: It is accepted that orthostatic hypotension is a clinical marker for the diagnosis of multiple system atrophy, but conflicting data indicate that it may also be present in Parkinson disease (PD). OBJECTIVES: To evaluate the prevalence of autonomic cardiovascular impairment and orthostatic hypotension in a large group of patients with de novo PD, followed up for at least 7 years, to clinically confirm the diagnosis of the disease. METHODS: During a 2-year recruiting period, 60 untreated patients diagnosed as having idiopathic PD underwent autonomic cardiovascular function evaluation using the Ewing test. Patients subsequently received dopaminergic therapy and their condition was followed up for at least 7 years. RESULTS: Nine (15%) of 60 patients were excluded from the study because during the follow-up period a parkinsonian syndrome was diagnosed (5 had multiple system atrophy and 4 had progressive supranuclear palsy). Data from 51 patients with PD underwent final statistical analysis and the results were compared with those of 51 age-matched healthy control subjects who had taken the same battery of autonomic tests. A statistically significant difference was found in postural hypotension (P =.02) and deep breathing test results (P =.03) between patients and controls. Seven (14%) of 51 patients with PD and 3 (60%) of 5 patients with multiple system atrophy had a decrease of more than 20 mm Hg in systolic blood pressure on standing. CONCLUSIONS: Data from this study indicate a high prevalence of sympathetic and parasympathetic failure in patients with de novo PD, and when using a decrease of at least 20 mm Hg in systolic blood pressure, manometric orthostatic hypotension was found in 7 (14%) of the 51 patients with de novo PD.

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  • Blunted or abolished variation in HR during deep breathing is suggestive of parasympathetic dysfunction.

    “There is strong consensus that blunted or abolished variation is suggestive of parasympathetic dysfunction. 142,143,146,147”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [146]

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Authors
Bonuccelli, U., Lucetti, C., Del Dotto, P., Ceravolo, R., Gambaccini, G., Bernardini, S., Rossi, G., & Piaggesi, A.
Affiliations
University of Pisa (IT)
ORCID
Venue
Archives of Neurology
Publisher
American Medical Association (AMA)
Published
2003-10-01
Volume
60
Issue
10
Pages
1400
ISSN
0003-9942 (ISSN-L)
DOI
10.1001/archneur.60.10.1400
OpenAlex
W2002469891
Cited by
103
References
38
Citations by year
2025: 1 · 2024: 1 · 2022: 1 · 2021: 9 · 2020: 5 · 2019: 8 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 5 · 2014: 3 · 2013: 9 · 2012: 5
FWCI
4.47
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
orthostatic hypotension, Parkinson's disease, autonomic dysfunction, multiple system atrophy, Ewing test, deep breathing test, dopaminergic therapy
MeSH terms
Autonomic Nervous System, Blood Pressure, Female, Follow-Up Studies, Heart Rate, Humans, Hypotension, Orthostatic, Male, Middle Aged, Parkinson Disease, Reflex, Valsalva Maneuver, Disease Progression, Hand Strength

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