Factors related to orthostatic hypotension in Parkinson's Disease.

SANTIAGO PEREZ-LLORET; VERÓNICA REY; NELLY FABRE; FABIENNE ORY-MAGNE; UMBERTO SPAMPINATO; JEAN-LOUIS MONTASTRUC; OLIVIER RASCOL

Buenos Aires, Argentina

Congreso; Congreso Internacional de Movimientos Anormales; 2010

Objective: To assess the concordance between a BP fall after orthostatism and the presence of hypotensivesymptoms as well as to explore factors related to the presence of OH.Background: Orthostatic hypotension (OH), a frequent feature of Parkinson´s Disease (PD) can contribute to fallsor other morbidity, thus warranting its diagnosis and treatment. They can be related to the disease itself or todrugs.Methods: Non-demented, non-operated PD out-patients were recruited at the Toulouse´s movement disordersclinic. Subjects were questioned about the presence of any hypotensive symptoms such as head lightness, blurredvision, falls or nausea after standing up or vertigo. Afterwards, BP was measured 5 min after lying down and 2 minafter standing up. OH was defined as systolic and/or diastolic BP fall 20 and/or10 mmHg within 2 min afterfall after ortostatism and not reporting any OH-related symptom.Results: 64 patients were included in this study. Mean age 67 10 years; 72% were males; mean UPDRS II or IIIin ON-state were 12 6 or 24 11. They were on L-Dopa/Agonists (99%), COMT-I (22%), Baroreflex-modifying(BR-M) drugs such as alpha-, beta-antagonists, Ca-channel blockers, amiodarone or Cholinesterase-inhibitors(17%), MAOB-I (12%) or fludrocortisone/midodrine (3%). Twenty-seven subjects (42%) showed hypotensivesymptoms and 28 (42%) had exaggerated BP fall. The agreement between the BP fall and the presence ofhypotensive symtoms was kappa= 0.16 0.12 (p=0.2). Twenty-four (37%) subjects were diagnosed with OH (i.e.BP fall + symptoms), whereas 14 (21%) were labeled as non-OH (i.e. no BP fall + no symptoms). Compared tonon-OH, OH subjects has higher UPDRS II in ON (14 1 vs 10 1, p<0.05), higher tremor score (4 1 vs 2 0.5,p<0.04) and were more frequently on amantadine (36% vs 8%) or BR-M drugs (37 vs 8%). Independent factorsrelated to OH as disclosed by logistic regression were amantadine (OR= 8.0, IC95%= 1.2-55.2) or BR-M drugsadministration (8.2, 1.1-55.5).Conclusions: In our study, the presence of orthostatic hypotension (defined as an exaggerated BP fall afterorthostatism plus hypotension symptoms) was related to amantadine or drugs able to modify baroreflex.