Adreno-medullary sympathetic nerves and ascending baroreceptor pathways are not affected in Parkinson's disease patients with orthostatic hypotension

Abstract

s from the Japanese Journal: The autonomic nervous system #1 Adreno-medullary sympathetic nerves and ascending baroreceptor pathways are not affected in Parkinson's disease patients with orthostatic hypotension Toshimasa Yamamoto, Akifumi Miyake, Toshinori Kimura, Yasuko Ohe, Naotoshi Tamura, Nobuo Araki Department of Neurology, Faculty of Medicine, Saitama Medical University, Saitama 350-0495, Japan We investigated whether the activity in adreno-medullary nerves and in ascending baroreceptor pathways in Parkinson's disease with orthostatic hypotension differs from that in multiple system atrophy. We examined noradrenergic, adreno-medullary, and ascending baroreceptor pathway abnormalities, by measuring plasma noradrenaline, adrenaline and arginine-vasopressin in Parkinson's disease patients with and without orthostatic hypotension, in multiple system atrophy patients with orthostatic hypotension and in healthy controls, before and during a 70° passive head-up tilt lasting 10 min. We found that elevation of plasma noradrenaline to tilt was significantly smaller in both sets of patients with orthostatic hypotension (compared to controls), but there was no difference between the two groups of patients. Elevation of plasma adrenaline to tilt was significantly higher in Parkinson's disease patients with orthostatic hypotension compared to the other two groups of patients. Elevation of plasma vasopressin to tilt was significantly higher in Parkinson's disease patients with orthostatic hypotension than in the other three groups. We conclude that noraderenergic pathways are functionally disturbed in patientswith Parkinson's diseasewith orthostatic hypotension. The functions of adreno-medullary nerves and of the ascending baroreceptor pathways are well preserved in Parkinson's disease with orthostatic hypotension, but are adversely affected in patients with multiple system atrophy. (The Autonomic Nervous System, 48: 251-257, 2011) doi:10.1016/j.autneu.2012.08.006 #2 Chrono-medical impact on morning hypertension therapy and home blood pressure measurement: The Val-HOPE study Kuniaki Otsuka, Kim Gwang U., Tatsushi Sugiura, Yoshiaki Harada, Keiko Mochizuki, Hamyuki Nakagawa, Hideaki Sudo and Val-HOPE study group Department of Medicine, Tokyo Women's Medical University Medical Center East Department of Internal Medicine, Nishi-Arai Hospital Department of Internal Medicine, Seiwa Clinic, Nishi-Arai Hospital Department of Internal Medicine, Harada Clinic Department of Internal Medicine, Nishikawa Clinic Department of Internal Medicine, Nakagawa Clinic Department of Internal Medicine, Johoku Clinic, Tokyo 116-8567, Japan We evaluated chrono-medically the effect of valsartan's therapy on home-measured blood pressure (BP) in patients, whose blood pressure was inadequately controlled with or without anti-hypertensive agents. The subjects were 42 men and 63 women, of average age of 63.4 years. Administration of valsartan significantly reduced blood pressure both at the clinic and at home, i.e., from 158.6±13.7/90.9±11.6 to 139.3±12.9/82.5±10.2 mmHg, and from 150.0±11.6/89.4±10.9 to 136.6±11.9/82.5±10.2 mm Hg (pb0.001), respectively. Morning and evening blood pressure levels were both significantly decreased (pb0.001), and the difference morning/evening dropped from 9.9/5.6 (systolic/diastolic) mmHg to 6.6/4.0 mmHg (pb0.05). In 34 subjects who suffered from amorning blood pressure surge and had a morning/ evening difference of more than 15 mmHg, the morning/evening difference decreased from 24.2±7.6 to 14.3±10.2 mmHg (pb0.001) after the valsartan treatment. Among 81 subjects whose systolic blood pressure levels in both morning and evening exceeded 135 mm Hg, 62 subjects showed a reduction of the evening blood pressure of over 5 mm Hg after administration of valsartan. In these 62 subjects, the ratio of the fall in pressure in the morning over that in the evening (M/E ratio, index of continuousness of antihypertensive action) was 1.13+0.62 when calculated in the individual patients and was 1.02 when calculated from mean values of the patient group. Depression symptoms were significantly alleviated (pb0.05), and no adverse events were seen. In conclusion the chrono-medical assessment of this study has shown that valsartan is a potential, well-tolerated antihypertensive agent. (The Autonomic Nervous System, 48: 258-265, 2011) doi:10.1016/j.autneu.2012.08.007 #3 Evaluation of chilly constitution in young women with a postural change test Shunji Sakaguchi, Yoshihisa Kojima, Junji Miyazaki, Hiroshi Kuge, Hidetoshi Mori Autonomic Neuroscience: Basic and Clinical 171 (2012) 89–91