Loss of nocturnal blood pressure fall in various extrapyramidal syndromes
Abstract
Cardiovascular autonomic dysfunction has frequently been reported in some patients with extrapyramidal syndromes, especially multiple system atrophy (MSA) but also Parkinson's disease (PD). However, there are only few reports on the prevalence of cardiovascular autonomic dysfunction progressive in supranuclear palsy (PSP). Moreover, the relation of detailed cardiovascular testing and easy to assess 24-hour ambulatory blood pressure (BP) is not known. Our study evaluates 24-hour ambulatory BP monitoring in patients with PD, PSP, MSA, and corresponding controls (Con) and relates the findings to the results of comprehensive cardiovascular autonomic testing. Twenty-three patients with PD, 25 patients with PSP, 25 patients with MSA, and 26 corresponding controls were studied by 24-hour ambulatory BP monitoring (ABPM) in comparison to cardiovascular autonomic testing. Patients with PD, PSP, and MSA presented frequently with a pathological nocturnal BP regulation (no decrease or even an increase of nocturnal BP) in comparison to the control group (PD 48%, PSP 40%, MSA 68% vs. Con 8%). In MSA and PD patients, the frequent pathological BP increase during night was closely correlated to orthostatic hypotension. Since loss of nocturnal BP fall is frequent in patients with extrapyramidal syndromes, even if they are free of subjective autonomic dysfunction, we recommend 24-hour ABPM as an easy to perform screening test, especially if detailed autonomic testing is not available. Pathological loss of nocturnal BP fall may account for increased cardiovascular mortality in extrapyramidal syndromes.
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OH is frequently associated with a nocturnal 'non-dipping' or even 'reverse-dipping' BP pattern in patients with autonomic failure, with relevant therapeutic and prognostic implications.
“There is strong evidence that OH is frequently associated with a nocturnal 'non-dipping' or even 'reverse-dipping' BP pattern in patients with autonomic failure, with relevant therapeutic and prognostic implications 140,148-151”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [149]
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- Authors
- Schmidt, C., Berg, D., Herting, Prieur, S., Junghanns, S., Schweitzer, K., Globas, C., Schöls, L., Reichmann, H., & Ziemssen, T.
- Affiliations
- University Hospital Carl Gustav Carus (DE)
- Hertie Institute for Clinical Brain Research (DE)
- Corresponding author
- Ziemssen, Tjalf
- Venue
- Movement Disorders
- Publisher
- Wiley
- Published
- 2009-09-18
- Volume
- 24
- Issue
- 14
- Pages
- 2136-2142
- ISSN
- 0885-3185 (ISSN-L)
- 1531-8257
- OpenAlex
- W2044916396
- Cited by
- 113
- References
- 27
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 8 · 2023: 5 · 2022: 9 · 2021: 11 · 2020: 1 · 2019: 3 · 2018: 10 · 2017: 6 · 2016: 14 · 2015: 7 · 2014: 9 · 2013: 10 · 2012: 5
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Movement Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- nocturnal blood pressure dipping, extrapyramidal symptoms, Parkinson's disease, progressive supranuclear palsy, multiple system atrophy, cardiac autonomic dysfunction, orthostatic hypotension, 24-hour ambulatory blood pressure monitoring, cardiovascular mortality
- MeSH terms
- Aged, Autonomic Nervous System, Autonomic Nervous System Diseases, Basal Ganglia Diseases, Blood Pressure, Circadian Rhythm, Cross-Sectional Studies, Female, Heart Rate, Humans, Hypertension, Male, Middle Aged, Parkinson Disease, Supranuclear Palsy, Progressive, Blood Pressure Monitoring, Ambulatory, Tilt-Table Test, Multiple System Atrophy
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