RESEARCH
ARTICLE
Orthostatic Hypotension in Parkinson Disease: How Much You Fall or How Low You Go? Jose-Alberto Palma, MD, PhD,1 Juan Carlos Gomez-Esteban, MD,2 Lucy Norcliffe-Kaufmann, PhD,1 Jose Martinez, MS,1 Beatriz Tijero, MD, PhD,2 Koldo Berganzo, MD, PhD,2 and Horacio Kaufmann, MD1* 1
Dysautonomia Center, Department of Neurology, New York University Medical Center, New York, New York, USA 2 Autonomic and Movement Disorders Unit, Department of Neurology, Hospital de Cruces, Bilbao, Spain
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 symp-
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*Correspondence to: Dr. Horacio Kaufmann, Dysautonomia Center, Department of Neurology, New York University Medical Center, 530 First Avenue, Suite 9Q, New York, NY 10016, USA; [email protected] Funding agencies: National Institutes of Health and the Dysautonomia Foundation, Inc. Relevant conflicts of interest/financial disclosures: J.-A.P. receives research support from the Dysautonomia Foundation, Inc. L.N.K. receives research support from the National Institutes of Health (U54NS065736) and the Dysautonomia Foundation, Inc. J.M. receives research support from the Dysautonomia Foundation, Inc. H.K. serves on a scientific advisory board for Lundbeck; serves as editor-in-chief of Clinical Autonomic Research, and receives research support from the National Institutes of Health (U54NS065736 [principal investigator; PI]), the U.S. Food and Drug Administration (FD-R-3731-01 [PI]), and the Dysautonomia Foundation, Inc. Full financial disclosures and author roles may be found in the online version of this article. Received: 28 July 2014; Revised: 14 September 2014; Accepted: 1 October 2014 Published online 12 February 2015 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mds.26079
toms 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
ARTICLE
Orthostatic Hypotension in Parkinson Disease: How Much You Fall or How Low You Go? Jose-Alberto Palma, MD, PhD,1 Juan Carlos Gomez-Esteban, MD,2 Lucy Norcliffe-Kaufmann, PhD,1 Jose Martinez, MS,1 Beatriz Tijero, MD, PhD,2 Koldo Berganzo, MD, PhD,2 and Horacio Kaufmann, MD1* 1
Dysautonomia Center, Department of Neurology, New York University Medical Center, New York, New York, USA 2 Autonomic and Movement Disorders Unit, Department of Neurology, Hospital de Cruces, Bilbao, Spain
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 symp-
------------------------------------------------------------
*Correspondence to: Dr. Horacio Kaufmann, Dysautonomia Center, Department of Neurology, New York University Medical Center, 530 First Avenue, Suite 9Q, New York, NY 10016, USA; [email protected] Funding agencies: National Institutes of Health and the Dysautonomia Foundation, Inc. Relevant conflicts of interest/financial disclosures: J.-A.P. receives research support from the Dysautonomia Foundation, Inc. L.N.K. receives research support from the National Institutes of Health (U54NS065736) and the Dysautonomia Foundation, Inc. J.M. receives research support from the Dysautonomia Foundation, Inc. H.K. serves on a scientific advisory board for Lundbeck; serves as editor-in-chief of Clinical Autonomic Research, and receives research support from the National Institutes of Health (U54NS065736 [principal investigator; PI]), the U.S. Food and Drug Administration (FD-R-3731-01 [PI]), and the Dysautonomia Foundation, Inc. Full financial disclosures and author roles may be found in the online version of this article. Received: 28 July 2014; Revised: 14 September 2014; Accepted: 1 October 2014 Published online 12 February 2015 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mds.26079
toms 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
