Factors related to orthostatic hypotension in Parkinson's Disease.

SANTAIGO PEREZ-LLORET; VERÓNICA REY; NELLY FABRE; FABIENNE ORY-MAGNE; UMBERTO SPAMPINATO; OLIVIER RASCOL

Toronto, Canada

Congreso; Congreso Internacional de Movimientos Anormales; 2011

Objective: To assess the concordance between abnormal BP fall after orthostatism and the presence ofhypotensive symptoms as well as to explore factors related to the presence of orthostatic hypotension.Background: Orthostatic hypotension (OH), a frequent feature of Parkinson´s Disease (PD) can contribute tofalls or other morbidity, thus warranting its diagnosis and treatment. It 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,blurred vision, falls or nausea after standing up or vertigo. Afterwards, BP was measured 5 min after lyingdown and 2 min after standing up. Abnormal BP fall was defined as systolic and/or diastolic BP fall 20 and/or10 mmHg 3 min after orthostatism.Results: 103 patients were included in this study (mean age= 66 1 years, 72% were males; mean diseaseduration= 9 1 years; mean UPDRS II+III in ON-state= 37 2 points. They were on L-Dopa/Agonists (99%),COMT-I (25%), MAOB-I (9%), amantadine (16%) or fludrocortisone/midodrine (4%). 41 subjects (40%)reported hypotensive symptoms and 38 (37%) had abnormal BP fall after orthostatism. The agreementbetween abnormal BP fall and presence of OH symtoms was low (kappa= 0.12 0.1, p=0.2). Subjects withabnormal BP fall were older (70 1 vs 64 1 p<0.05), had higher UPDRS II+III score (42.2 2.8 vs 33.3 2.1p<0.01), were less frequently on COMT inhibitors (13% vs 32% p<0.05), more frequently on amantadine(29% vs 8%, p<0.01) and on polymedication (i.e. > 5 drugs; 53% vs 26% p<0.01). Independent factorsrelated to exaggerated BP fall, as assessed by logistic regression were age >67 years (OR= 3.4, 1.3-9.0),polymedication (3.7, 1.4-9.5), amantadine (6.3, 1.7-24.0), whereas COMT inhibitors were protective (0.2,0.1-0.8). UPDRS II+III score was not related to BP fall (2.1, 0.8-5.5).Conclusions: Low concordance between exaggerated BP fall and OH symptoms was observed. The former wasrelated to older age and pharmacological