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25.04.2024 | Research Article

Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson’s disease

verfasst von: Fabrizio Vallelonga, Matteo Valente, Marta Maria Tangari, Anna Covolo, Valeria Milazzo, Cristina Di Stefano, Gabriele Sobrero, Marta Giudici, Alberto Milan, Franco Veglio, Leonardo Lopiano, Simona Maule, Alberto Romagnolo

Erschienen in: Clinical Autonomic Research | Ausgabe 2/2024

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Abstract

Purpose

Neurogenic orthostatic hypotension (nOH) is a frequent nonmotor feature of Parkinson’s disease (PD), associated with adverse outcomes. Recently, 24-h ambulatory blood pressure monitoring (ABPM) showed good accuracy in diagnosing nOH. This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to the well-defined prognostic role of bedside nOH.

Methods

Patients with PD who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, and mortality, during an up-to-10-year follow-up. Significant ABPM-hypotensive episodes were identified when greater than or equal to two episodes of systolic BP drop ≥ 15 mmHg (compared with the average 24 h) were recorded during the awakening-to-lunch period.

Results

A total of 99 patients (74% male, age 64.0 ± 10.1 years, and PD duration 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH.

On Kaplan–Meier analysis, patients with ABPM-hypotensive episodes showed earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and shorter survival (8.0 versus 9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and Hoehn and Yahr stage) a significant association was confirmed between ABPM-hypotensive episodes and falls [odds ratio (OR) 3.626; p = 0.001), hospitalizations (OR 2.016; p = 0.038), and dementia (OR 2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR 1.908; p = 0.048).

Conclusions

The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.

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Titel: Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson’s disease
verfasst von: Fabrizio Vallelonga
Matteo Valente
Marta Maria Tangari
Anna Covolo
Valeria Milazzo
Cristina Di Stefano
Gabriele Sobrero
Marta Giudici
Alberto Milan
Franco Veglio
Leonardo Lopiano
Simona Maule
Alberto Romagnolo
Publikationsdatum: 25.04.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Autonomic Research / Ausgabe 2/2024
Print ISSN: 0959-9851
Elektronische ISSN: 1619-1560
DOI: https://doi.org/10.1007/s10286-024-01030-7

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Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson’s disease