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October 15, 2019; 93 (16) Article

Orthostatic hypotension in Parkinson disease

A 7-year prospective population-based study

View ORCID ProfileYlva Hivand Hiorth, Kenn Freddy Pedersen, Ingvild Dalen, Ole-Bjørn Tysnes, View ORCID ProfileGuido Alves
First published September 16, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008314
Ylva Hivand Hiorth
From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway.
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Kenn Freddy Pedersen
From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway.
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Ingvild Dalen
From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway.
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Ole-Bjørn Tysnes
From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway.
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Guido Alves
From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway.
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Orthostatic hypotension in Parkinson disease
A 7-year prospective population-based study
Ylva Hivand Hiorth, Kenn Freddy Pedersen, Ingvild Dalen, Ole-Bjørn Tysnes, Guido Alves
Neurology Oct 2019, 93 (16) e1526-e1534; DOI: 10.1212/WNL.0000000000008314

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Abstract

Objective To determine the frequency, evolution, and associated features of orthostatic hypotension (OH) over 7 years of prospective follow-up in a population-based, initially drug-naive Parkinson disease (PD) cohort.

Methods We performed repeated lying and standing blood pressure measurements in 185 patients with newly diagnosed PD and 172 matched normal controls to determine the occurrence of (1) OH using consensus-based criteria and (2) clinically significant OH (mean arterial pressure in standing position ≤75 mm Hg). We applied generalized estimating equations models for correlated data to investigate associated features of these 2 outcomes in patients with PD.

Results OH was more common in patients with PD than controls at all visits, with the relative risk increasing from 3.0 (95% confidence interval [CI] 1.6–5.8; p < 0.001) at baseline to 4.9 (95% CI 2.4–10.1; p < 0.001) after 7 years. Despite a high cumulative prevalence of OH (65.4%) and clinically significant OH (29.2%), use of antihypotensive drugs was very rare (0.5%). OH was independently associated with older age (odds ratio [OR] 1.06 per year; 95% CI 1.03–1.10), lower Mini-Mental State Examination score (OR 0.91 [0.85–0.97] per unit), and longer follow-up time (OR 1.12 [1.03–1.23] per year). Clinically significant OH was associated with the same characteristics, in addition to higher levodopa equivalent dosage (OR 1.16 [1.07–1.25] per 100 mg).

Conclusions In this population-based study, we found OH to be a very frequent but undertreated complication in early PD, with associations to both disease-specific symptoms and drug treatment. Our findings suggest that clinicians should more actively assess and manage OH abnormalities in PD.

Glossary

BP=
blood pressure;
CI=
confidence interval;
GEE=
generalized estimating equation;
IQR=
interquartile range;
LED=
levodopa equivalent dose;
MAP=
mean arterial pressure;
MMSE=
Mini-Mental State Examination;
OH=
orthostatic hypotension;
OR=
odds ratio;
PD=
Parkinson disease;
PIGD=
postural instability/gait difficulty;
RR=
relative risk;
UPDRS=
Unified Parkinson’s Disease Rating Scale

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Podcast: NPub.org/vccv97

  • CME Course: NPub.org/cmelist

  • Received February 7, 2019.
  • Accepted in final form May 16, 2019.
  • © 2019 American Academy of Neurology
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