Abstract
Non-motor aspects of Parkinson disease (PD) are now recognized to be important both
clinically and scientifically. Among these facets are abnormalities in blood pressure
regulation. As much as 40% of PD patients have orthostatic hypotension (OH), which
is usually associated with supine hypertension (SH). Symptoms of OH range from light-headedness
to falls with serious trauma. SH, while typically asymptomatic, poses a significant
increased risk for cardiovascular morbidity and mortality. Neuroimaging, neurochemical,
and neuropharmacological studies indicate cardiac and extra-cardiac sympathetic noradrenergic
denervation and baroreflex failure in virtually all PD patients with OH, and cardiac
sympathetic denervation has been confirmed histopathologically. Mechanisms of SH in
PD+OH remain poorly understood. The diurnal blood pressure profile shows increased variability
that is correlated with decreased baroreflex gain and with increased morbidity and
mortality. Treatment should be individually tailored according to the timing of OH
or SH, using primarily short-acting sympathomimetic medications in the daytime for
OH and short-acting antihypertensive in the nighttime for SH. Future research is needed
to understand better and attenuate blood pressure fluctuations through manipulations
that improve baroreflex function.
Abbreviations:
PD (Parkinson disease), OH (orthostatic hypotension), SH (supine hypertension, SNS, sympathetic nervous system, MSA, multiple system atrophy), PAF (pure autonomic failure), NE (norepinephrine)Keywords
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Article info
Publication history
Published online: July 15, 2011
Accepted:
June 25,
2011
Received in revised form:
May 26,
2011
Received:
February 16,
2011
Footnotes
☆The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
