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Twenty‐four‐hour ambulatory blood pressure and heart rate profiles in diagnosing orthostatic hypotension in Parkinson's disease and multiple system atrophy
Author(s) -
Vichayanrat E.,
Low D. A.,
Iodice V.,
Stuebner E.,
Hagen E. M.,
Mathias C. J.
Publication year - 2017
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13135
Subject(s) - medicine , orthostatic vital signs , ambulatory blood pressure , cardiology , blood pressure , pure autonomic failure , atrophy , heart rate , ambulatory , parkinson's disease , circadian rhythm , heart failure , autonomic nervous system , disease
Background and purpose Twenty‐four‐hour ambulatory blood pressure and heart rate monitoring (24‐h ABPM ) can provide vital information on circadian blood pressure ( BP ) profiles, which are commonly abnormal in Parkinson's disease with and without autonomic failure ( PD + AF and PD ) and multiple system atrophy ( MSA ). Twenty‐four‐hour ABPM has not been directly compared between these disorders regarding cardiovascular autonomic function. Our aim was to determine the usefulness of 24‐h ABPM with diary compared to head‐up tilting ( HUT ) in diagnosing orthostatic hypotension ( OH ) in these patients. Methods Seventy‐four patients (23 MSA , 18 PD + AF , 33 PD ) underwent cardiovascular autonomic screening followed by 24‐h ABPM with diary. Standing tests were included during 24‐h ABPM . The sensitivity and specificity in detecting OH from the 24‐h ABPM standing test were compared with HUT . Results There was no difference in OH during HUT between MSA and PD + AF ( P > 0.05). There was a higher proportion of abnormal BP circadian rhythms in MSA and PD + AF compared to PD ( P < 0.05) but not between MSA and PD + AF ( P > 0.05). Patients were divided into groups with OH ( OH +) and without OH ( OH −) on HUT . Using the standing test during 24‐h ABPM , a systolic BP fall of >20 mmHg showed a sensitivity and specificity of 82% and 100% (area under the curve 0.91, 95% confidence interval 0.84–0.98) in differentiating OH + from OH −. Conclusions Parkinson's disease with autonomic failure and MSA patients had similar circadian BP patterns suggesting that autonomic dysfunction influences abnormal BP circadian patterns similarly in these disorders. The higher sensitivity and specificity in detecting OH using a systolic BP fall of >20 mmHg compared to a diastolic BP fall of >10 mmHg during the standing test supports its usefulness to assess autonomic function in MSA and PD .