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Low, DA, Vichayanrat, E, Iodice, V, Mathias, CJ, Hagen, EM and Stuebner, E (2017) 24 hour-ambulatory blood pressure and heart rate profiles in diagnosing orthostatic hypotension in Parkinson’s disease and Multiple System Atrophy. European Journal of Neurology, 24 (1). pp. 90-97. ISSN 1468-1331
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Abstract
Background:24-hour ambulatory blood pressure and heart rate monitoring (24hr-ABPM) can provide vital information on circadian blood pressure (BP) profiles, which are commonly abnormal in Parkinson’s disease with and without autonomic failure (PD+AF and PD) and multiple system atrophy (MSA). 24hr-ABPM has not been directly compared between these disorders regarding cardiovascular autonomic function. We aim to determine the usefulness of 24hr-ABPM with diary compared to Head-up Tilting (HUT) in diagnosing orthostatic hypotension (OH) in these patients.
Methods: 74 patients (23 MSA,18 PD+AF,33 PD) underwent cardiovascular autonomic screening followed by 24hr-ABPM with diary. Standing tests were included during 24hr-ABPM. The sensitivity and specificity in detecting OH from the 24hr-ABPM standing test were compared with HUT.
Results: There was no difference in OH during HUT between MSA and PD+AF (p>0.05). MSA and PD+AF had a higher proportion of abnormal BP circadian rhythms compared to PD (p<0.05) but not between MSA and PD+AF (p>0.05). Patients were divided into groups with (OH+) and without OH (OH-) on HUT. Using the standing test during 24hr-ABPM, a SBP fall of >20 mmHg showed a sensitivity and specificity of 82% and 100 % (AUC 0.91, 95% CI 0.84-0.98) in differentiating OH+ from OH-, respectively.
Conclusions:PD+AF and MSA patients had similar circadian BP patterns suggesting that autonomic dysfunction influences abnormal BP circadian patterns similarly in these disorders. The higher sensitivity and specificity in detecting OH using a SBP fall of >20 mmHg compared to a DBP fall of >10 mmHg during standing test supports its usefulness to assess autonomic function in MSA and PD.
| Item Type: | Article |
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| Additional Information: | This is the peer reviewed version of the following article: Vichayanrat, E., Low, D. A., Iodice, V., Stuebner, E., Hagen, E. M. and Mathias, C. J. (2017), Twenty-four-hour ambulatory blood pressure and heart rate profiles in diagnosing orthostatic hypotension in Parkinson's disease and multiple system atrophy. Eur J Neurol, 24: 90–9 which has been published in final form at http://dx.doi.org/10.1111/ene.13135 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving |
| Uncontrolled Keywords: | 1103 Clinical Sciences, 1109 Neurosciences |
| Subjects: | R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry |
| Divisions: | Sport & Exercise Sciences |
| Publisher: | Wiley: 12 months |
| Date Deposited: | 16 Aug 2016 13:32 |
| Last Modified: | 20 Apr 2022 09:11 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/4030 |
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