Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

Abstract

Abstract-Supine hypertension occurs commonly in primary chronic autonomic failure. This study explored whether supine hypertension in this setting is associated with orthostatic hypotension (OH), and if so, what mechanisms might underlie this association. Supine and upright blood pressures, hemodynamic responses to the Valsalva maneuver, baroreflex-cardiovagal gain, and plasma norepinephrine (NE) levels were measured in pure autonomic failure (PAF), multiple-system atrophy (MSA) with or without OH, and Parkinson's disease (PD) with or without OH. Controls included age-matched, healthy volunteers and patients with essential hypertension or those referred for dysautonomia. Baroreflex-cardiovagal gain was calculated from the relation between the interbeat interval and systolic pressure during the Valsalva maneuver. PAF, MSA with OH, and PD with OH all featured supine hypertension, which was equivalent in severity to that in essential hypertension, regardless of fludrocortisone treatment. Among patients with PD or MSA, those with OH had higher mean arterial pressure during supine rest (109Ϯ3 mm Hg) than did those lacking OH (96Ϯ3 mm Hg, Pϭ0.002). Baroreflex-cardiovagal gain and orthostatic increments in plasma NE levels were markedly decreased in all 3 groups with OH. Among patients with PD or MSA, those with OH had much lower mean baroreflex-cardiovagal gain (0.74Ϯ0.10 ms/mm Hg) than did those lacking OH (3.13Ϯ0.72 ms/mm Hg, Pϭ0.0002). In PAF, supine hypertension is linked to both OH and low baroreflex-cardiovagal gain. The finding of lower plasma NE levels in patients with than without supine hypertension suggests involvement of pressor mechanisms independent of the sympathetic nervous system. Key Words: hypertension, essential Ⅲ hypotension Ⅲ Parkinson's disease Ⅲ autonomic nervous system Ⅲ sympathetic nervous system Ⅲ norepinephrine P rimary chronic autonomic failure has been classified clinically into 3 forms: pure autonomic failure (PAF), multiple-system atrophy (MSA), and autonomic failure in the setting of Parkinson's disease (PD). 1 All 3 forms typically include orthostatic hypotension (OH), wherein reflexive increases in sympathetic neurocirculatory tone fail to compensate adequately for decreased venous return to the heart.Patients with primary chronic autonomic failure also often have supine hypertension. 2 Because of widespread use of the salt-retaining steroid fludrocortisone to treat OH and literature documenting increases in blood pressure secondary to mineralocorticoid administration, 3,4 supine hypertension in primary chronic autonomic failure might be a side effect of treating the OH and not part of the disease; however, supine hypertension has been reported in a substantial proportion of untreated patients. 5 Analogously, levodopa is a mainstay in the treatment of PD, and based on literature that levodopa produces OH, 6 OH in PD might be a side effect of treating the movement disorder and not part of the disease; however, OH occurs in at least some patients with PD who are off or have never been ...

White matter hyperintensities in patients with multiple system atrophy

“…In terms of the natural history of supine hypertension in patients with MSA, our present data together with results from other studies suggest that supine hypertension may function as a predisposing factor for the development of hypertensive target-organ damage in the cerebrocardiac system. Interestingly, pressor agent use did not influence the incidence of supine hypertension in patients with MSA, which was in line with previous reports that supine hypertension occurred in patients with MSA regardless of pressor agent use [10]. Furthermore, in our study, the use of pressor agents and disease duration did not significantly correlate with the severity of WMH.…”

Non-dipping nocturnal blood pressure and psychosis parameters in Parkinson disease

“…The former is also a symptom of an impaired cardiovascular autonomic nervous system, and was thus not unexpected; although only 2 patients met the clinical criteria for OH (correlation was conducted with scale data). Previous studies have reported an association with OH and supine hypertension [44] which could serve as an explanation for non-dipping in PD. The association of non-dipping with UPDRS scores is also not surprising given that cardiovascular symptoms are scored as part of the UPDRS and that cardiovascular autonomic dysfunction generally tends to occur in the latter stages of PD.…”

En mann med invalidiserende ortostatisk hypotensjon

“…multisystematrofi eller langtkommet Parkinsons sykdom). Nattlig hypertensjon er vanlig hos pasienter med nevrogen ortostatisk hypotensjon (10,11). Blodtrykket er normalt 10-20 % lavere om natten enn om dagen.…”

“…Forverring av ortostatiske symptomer etter måltider er vanlig hos pasienter med nevrogen ortostatisk hypotensjon (9). Det er også vanlig, men lite kjent, at pasientene har hypertensjon i liggende stilling (10,11). Det har vaert anbefalt å heve sengens hodeende for å motvirke dette (3).…”