Delayed orthostatic hypotension in Parkinson\u2019s disease

Sang-Won Yoo,Eunkyeong Yun,Joong-Seok Kim,Kwang-Soo Lee,Ji-Yeon Yoo,Na-Young Shin,Uicheul Yoon

doi:10.1038/s41531-021-00181-y

Sang-Won Yoo, Eunkyeong Yun + Show 5 more

Open Access

https://doi.org/10.1038/s41531-021-00181-y

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Abstract

Orthostatic hypotension (OH) is relatively common in the early stage of Parkinson’s disease (PD). It is divided into delayed OH and classical OH. Classical OH in PD has been investigated widely, however, the clinical implications of delayed OH in PD have seldom been studied. The purpose of this study is to characterize delayed OH in PD. A total of 285 patients with early drug-naïve PD were enrolled and divided into three groups according to orthostatic change: no-OH, delayed OH, and classical OH. The disease severity in terms of motor, non-motor, and cognitive functions was assessed. The cortical thickness of 82 patients was analyzed with brain magnetic resonance imaging. The differences among groups and linear tendency in the order of no-OH, delayed OH, and classical OH were investigated. Seventy-seven patients were re-evaluated. Initial and follow-up evaluations were explored to discern any temporal effects of orthostasis on disease severity. Sixty-four (22.5%) patients were defined as having delayed OH and 117 (41.1%) had classical OH. Between-group comparisons revealed that classical OH had the worst outcomes in motor, non-motor, cognitive, and cortical thickness, compared to the other groups. No-OH and delayed OH did not differ significantly. Linear trends across the pre-ordered OH subtypes found that clinical parameters worsened along with the orthostatic challenge. Clinical scales deteriorated and the linear gradient was maintained during the follow-up period. This study suggests that delayed OH is a mild form of classical OH in PD. PD with delayed OH has milder disease severity and progression.

Highlights

Dysautonomia is a well-known non-motor feature that is discovered in the prodrome of Parkinson’s disease (PD)[1,2]
Classical Orthostatic hypotension (OH) is conventionally defined as sustained decrease in systolic blood pressure (SBP) ≥ 20 mmHg and/or diastolic blood pressure (DBP) 10 mmHg within 3 min of standing, and delayed OH is considered when the progressive blood pressure drop surpasses the margin of change after 3 min
Its significance was seldom studied in populations with PD, a longitudinal follow-up study revealed some individuals with delayed OH progressed to classical OH and developed αsynucleinopathy[11]

Summary

Introduction

Dysautonomia is a well-known non-motor feature that is discovered in the prodrome of Parkinson’s disease (PD)[1,2]. OH is clinically divided into classical OH and delayed OH8,9. Classical OH is conventionally defined as sustained decrease in systolic blood pressure (SBP) ≥ 20 mmHg and/or diastolic blood pressure (DBP) 10 mmHg within 3 min of standing, and delayed OH is considered when the progressive blood pressure drop surpasses the margin of change after 3 min. The clinical implications of delayed OH are suggested to be a non-benign, mild, or early form of sympathetic adrenergic dysfunction[10]. Its significance was seldom studied in populations with PD, a longitudinal follow-up study revealed some individuals with delayed OH progressed to classical OH and developed αsynucleinopathy[11]

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