Association of transient orthostatic hypotension with falls and syncope in patients with Parkinson disease
Association of transient orthostatic hypotension with falls and syncope in patients with Parkinson disease
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DOI：
10.1212/wnl.0000000000010749
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发表时间：
2020-11-24
期刊：
影响因子：
9.9
通讯作者：
Wenning, Gregor K.
中科院分区：
文献类型：
--
作者：
Fanciulli, Alessandra;Campese, Nicole;Wenning, Gregor K.
为探讨一过性立位性低血压(TOH)在帕金森病(PD)患者中的发生率及其临床影响，我们对173例PD患者和173例年龄、性别相匹配的立位耐受患者进行了心血管自主神经功能的连续无创血压监测。方法筛选TOH(立位后1分钟内收缩压下降或舒张压下降=20 mm Hg或舒张压下降=10 mm Hg)和经典血压下降(Coh，持续收缩压下降或舒张压下降=10 mm Hg)。在PD患者中，我们回顾了自主神经测试前6个月和之后6个月的跌倒、晕厥和立位耐受史的医疗记录。结果与临床人口统计或PD特有的特征无关，24%的PD患者和21%的对照组发生COH，19%的PD患者发生COH，而对照组没有出现COH。40%的帕金森病患者有跌倒的病史，29%的患者是由于晕厥。有立位耐力不耐受和晕厥病史的PD患者立位时收缩压下降和舒张压下移更为严重，且以30~60s最为明显。结论StOH是一种年龄依赖性现象，至少与CoH一样常见。床边血压测量可以忽略直立位时的一过性血压下降，但会导致帕金森病患者的立位不耐受和晕厥。站立时持续的无创性血压监测可能有助于确定帕金森病患者同步跌倒的可改变的危险因素。
ObjectivesTo assess the frequency of transient orthostatic hypotension (tOH) and its clinical impact in Parkinson disease (PD), we retrospectively studied 173 patients with PD and 173 age- and sexmatched controls with orthostatic intolerance, who underwent cardiovascular autonomic function testing under continuous noninvasive blood pressure (BP) monitoring.MethodsWe screened for tOH (systolic BP fall >= 20mmHg or diastolic >= 10mmHg resolving within the first minute upon standing) and classic OH (cOH, sustained systolic BP fall >= 20 mm Hg or diastolic >= 10 mm Hg within 3 minutes upon standing). In patients with PD, we reviewed the medical records of the 6 months preceding and following autonomic testing for history of falls, syncope, and orthostatic intolerance.ResultstOH occurred in 24% of patients with PD and 21% of controls, cOH in 19% of patients with PD and in none of the controls, independently of any clinical-demographic or PD-specific characteristic. Forty percent of patients with PD had a history of falls, in 29% of cases due to syncope. Patients with PD with history of orthostatic intolerance and syncope had a more severe systolic BP fall and lower diastolic BP rise upon standing, most pronounced in the first 30-60 seconds.ConclusionstOH is an age-dependent phenomenon, which is at least as common as cOH in PD. Transient BP falls when changing to the upright position may be overlooked with bedside BP measurements, but contribute to orthostatic intolerance and syncope in PD. Continuous noninvasive BP monitoring upon standing may help identify a modifiable risk factor for syncoperelated falls in parkinsonian patients.