Orthostatic hypotension in Parkinson disease: how much you fall or how low you go?
Identifieur interne : 000135 ( Main/Exploration ); précédent : 000134; suivant : 000136Orthostatic hypotension in Parkinson disease: how much you fall or how low you go?
Auteurs : Jose-Alberto Palma [États-Unis] ; Juan Carlos Gomez-Esteban ; Lucy Norcliffe-Kaufmann ; Jose Martinez ; Beatriz Tijero ; Koldo Berganzo ; Horacio KaufmannSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2015.
Abstract
Orthostatic hypotension (OH) is frequent in patients with Parkinson's disease (PD) and can occur with or without symptoms. Pharmacological treatments are effective, but often exacerbate supine hypertension. Guidelines exist for the diagnosis, but not for the treatment of OH. We examined the relationship between blood pressure (BP) and symptoms in a cohort of PD patients with the goal of identifying a hemodynamic target to guide treatment. We measured BP supine and upright (tilt or active standing) and identified the presence or absence of symptomatic OH by using a validated patient-reported outcome questionnaire in 210 patients with PD. We evaluated the usefulness of the 20/10 and 30/15 mmHg diagnostic criteria (systolic/diastolic) to identify symptomatic OH. Fifty percent of the PD patient cohort met criteria for the 20/10 fall and 30% for the 30/15 BP fall. Among the patients who met either OH criteria, the percentage of those with symptoms was small (33% of those with 20/10 and 44% of those with 30/15 mmHg; 16% and 13%, respectively, overall). Symptomatic OH was associated with an upright mean BP below 75 mmHg. A mean standing BP <75 mmHg had a sensitivity of 97% and a specificity of 98% for detecting symptomatic OH. Although the prevalence of OH in PD is high, not all patients have symptoms of organ hypoperfusion. A mean standing BP below 75 mmHg appears to be a useful benchmark when deciding whether the benefits of initiating pharmacological treatment of OH outweigh the risks of exacerbating supine hypertension.
DOI: 10.1002/mds.26079
PubMed: 25678194
Affiliations:
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Pharmacological treatments are effective, but often exacerbate supine hypertension. Guidelines exist for the diagnosis, but not for the treatment of OH. We examined the relationship between blood pressure (BP) and symptoms in a cohort of PD patients with the goal of identifying a hemodynamic target to guide treatment. We measured BP supine and upright (tilt or active standing) and identified the presence or absence of symptomatic OH by using a validated patient-reported outcome questionnaire in 210 patients with PD. We evaluated the usefulness of the 20/10 and 30/15 mmHg diagnostic criteria (systolic/diastolic) to identify symptomatic OH. Fifty percent of the PD patient cohort met criteria for the 20/10 fall and 30% for the 30/15 BP fall. Among the patients who met either OH criteria, the percentage of those with symptoms was small (33% of those with 20/10 and 44% of those with 30/15 mmHg; 16% and 13%, respectively, overall). Symptomatic OH was associated with an upright mean BP below 75 mmHg. A mean standing BP <75 mmHg had a sensitivity of 97% and a specificity of 98% for detecting symptomatic OH. Although the prevalence of OH in PD is high, not all patients have symptoms of organ hypoperfusion. A mean standing BP below 75 mmHg appears to be a useful benchmark when deciding whether the benefits of initiating pharmacological treatment of OH outweigh the risks of exacerbating supine hypertension.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>État de New York</li></region></list><tree><noCountry><name sortKey="Berganzo, Koldo" sort="Berganzo, Koldo" uniqKey="Berganzo K" first="Koldo" last="Berganzo">Koldo Berganzo</name><name sortKey="Gomez Esteban, Juan Carlos" sort="Gomez Esteban, Juan Carlos" uniqKey="Gomez Esteban J" first="Juan Carlos" last="Gomez-Esteban">Juan Carlos Gomez-Esteban</name><name sortKey="Kaufmann, Horacio" sort="Kaufmann, Horacio" uniqKey="Kaufmann H" first="Horacio" last="Kaufmann">Horacio Kaufmann</name><name sortKey="Martinez, Jose" sort="Martinez, Jose" uniqKey="Martinez J" first="Jose" last="Martinez">Jose Martinez</name><name sortKey="Norcliffe Kaufmann, Lucy" sort="Norcliffe Kaufmann, Lucy" uniqKey="Norcliffe Kaufmann L" first="Lucy" last="Norcliffe-Kaufmann">Lucy Norcliffe-Kaufmann</name><name sortKey="Tijero, Beatriz" sort="Tijero, Beatriz" uniqKey="Tijero B" first="Beatriz" last="Tijero">Beatriz Tijero</name></noCountry><country name="États-Unis"><region name="État de New York"><name sortKey="Palma, Jose Alberto" sort="Palma, Jose Alberto" uniqKey="Palma J" first="Jose-Alberto" last="Palma">Jose-Alberto Palma</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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