Search Results (8)

Background/Objectives: Parkinson’s disease (PD) and hypertension are often coexistent conditions that interact in entwined ways at various levels. Cardiovascular autonomic dysfunction (CAD), a non-motor feature of PD occurring across all stages, alters blood pressure (BP) regulation. Methods: We conducted a cross-sectional study enrolling patients with PD and primary hypertension, without diabetes mellitus or other causes of secondary CAD, aiming to characterize BP profiles/patterns by ambulatory BP monitoring. We also sought associations between different CAD phenotypes and PD characteristics, disability, and cardiovascular comorbidities. Results: We included 47 patients with a median age of 71 years, PD duration of 9 years, and Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III score of 40. Diurnal and nocturnal BP values were within the reference range, but BP load was excessive. Almost one-third had neurogenic orthostatic hypotension (OH) and 80% were non-dippers. The overall burden of non-motor symptoms was significant in these phenotypes. Patients with neurogenic OH were more prone to constipation, anxiety, and urinary problems, whereas gustatory dysfunction, loss of libido, and erectile dysfunction were more frequently reported by non-dippers. No significant differences with regard to cognitive decline were identified in subjects with and without neurogenic OH. Neurogenic OH was symptomatic in 78% of the cases, whereas 56% of those with orthostatic symptoms did not have OH at repeated measurements. Conclusions: Neurogenic OH is an independent predictor of disability in patients with PD and hypertension, after adjusting for PD duration, Hoehn and Yahr stage, levodopa equivalent daily dose (LEDD), and Montreal Cognitive Assessment (MoCA) score. Full article

Background: Orthostatic hypotension (OH) is a chronic, debilitating condition common in older adults. This study examined the effects of daily lifestyle habits on non-neurogenic OH in older adults in South Korea. We further compared the effects of daily lifestyle habits on OH to those of the autonomic nervous system (ANS) function. Methods: In a cross-sectional study, 217 community-dwelling older adults aged ≥65 years were recruited using the convenience sampling method. Data were collected using two questionnaires to assess OH and daily lifestyle habits: OH was measured by Orthostatic Grading Scale (OGS) and lifestyle habits included nutrition, sleep, physical activity, and psychological status (stress and depression levels). Plasma catecholamines (epinephrine and norepinephrine) were measured to indicate the ANS function. The data were analyzed using t-tests, Pearson’s correlation coefficients, and multiple linear regression analysis. Results: Significant factors related to OGA score included nutritional status (B = −0.20, p ≤ 0.040), poorer sleep quality (B = 0.15, p = 0.005), physical activity (B = −0.01, p = 0.032), stress (B = 0.04, p = 0.001), and depression (B = 0.23, p = 0.001). These together explained 40.5% of the variance in OH. However, no significant association was found between catecholamines and OGS score. Conclusions: These results suggest that lifestyle habits are important factors, while ANS function may be less associated with non-neurogenic OH. Thus, preventive and non-pharmacological interventions for decreasing OH symptoms should focus on maintaining healthy lifestyle habits in older adults. Full article

Background: Neurogenic orthostatic hypotension (NOH) is a significant non-motor manifestation of Parkinson’s disease (PD), that substantially affects patient disability and has a powerful impact on the quality of life of PD patients, while also contributing to increased healthcare costs. This narrative review aims to summarize key insights into the diagnosis and management of NOH in individuals with PD. Methods: For diagnosing NOH, a recently introduced and valuable metric is the ΔHr/ΔSBP index. Additional tools, such as autonomic reflex testing and various blood tests, also can be used to help distinguish orthostatic hypotension (OH) from NOH. Results: Treatment strategies for NOH involve both non-pharmacological and pharmacological approaches. As NOH frequently coexists with other abnormal blood pressure patterns (supine hypertension, nocturnal hypertension, and non-dipping hypertension), its treatment can be a challenge for the clinician. Droxidopa and midodrine are the primary pharmacological agents for NOH, though emerging therapies, such as norepinephrine transporter inhibitors, are being investigated. Conclusions: Despite these advancements, further research is needed to better understand the underlying pathophysiology of NOH, enabling more tailored and effective treatment options for individuals with PD. Full article

Background/Objectives: Patients with postural orthostatic tachycardia syndrome (POTS) or neurogenic orthostatic hypotension (nOH) experience vertigo, confusion, and syncope. Compression garments help reduce venous pooling in these patients, thereby increasing cardiac output. We aimed to determine end-user opinions of compression products intended to alleviate symptoms for POTS and nOH. Methods: This was a survey study sampling participants diagnosed with POTS or nOH. The data collected included demographics, medical history, and compression garments previously used. The participants rated their most frequently used garment across comfort, aesthetic appeal, ease of use, durability, cost-effectiveness, efficacy, and consistency on the Likert scale (1–5). One-way ANOVA was used to compare the design criteria ratings across garments. For all tests α = 0.05. Results: Of the 330 POTS and 28 nOH participants surveyed (mean age 37.9, mean BMI 27.5, 95.0% women, 90.5% White), 354 (98.9%) reported trying at least one compression garment since their diagnosis. The majority of participants reported using leg compression most frequently rather than shapewear or abdominal compression (65.4% vs. 20.1% vs. 13.4%, respectively). Approximately 67.0% of participants tried multiple product types. Shapewear was reported to have greater concealability compared to abdominal or leg compression garments (mean 3.43 vs. 2.90 vs. 2.91, respectively; p < 0.01). Shapewear and abdominal compression were rated to be less comfortable compared to leg compression (2.67 vs. 2.94 vs. 3.05, respectively; p = 0.03). Conclusions: The existing compression products do not fully meet needs of individuals with POTS or nOH, as evidenced by participant ratings on multiple domains. There is potential consumer demand for novel adjustable abdominal compression garments that are low-profile and comfortable when disengaged. Full article

The genetic basis of Neurogenic Orthostatic Hypotension (NOH) in Parkinson’s disease (PD) has been inadequately explored. In a cross-sectional study, we examined the association between NOH and PD-related single-nucleotide polymorphisms (SNPs) and mapped their effects on gene expression and metabolic and signaling pathways. Patients with PD, free from pathological conditions associated with OH, and not taking OH-associated medications were included. NOH was defined as per international guidelines. Logistic regression was used to relate SNPs to NOH. Linkage-disequilibrium analysis, expression quantitative trait loci, and enrichment analysis were used to assess the effects on gene expression and metabolic/signaling pathways. We included 304 PD patients in the study, 35 of whom had NOH (11.5%). NOH was more frequent in patients with SNPs in SNCA, TMEM175, FAM47E-STBD1, CCDC62, SCN3A, MIR4696, SH3GL2, and LZTS3/DDRGK1 and less frequent in those with SNPs in ITGA8, IP6K2, SIPA1L2, NDUFAF2. These SNPs affected gene expression associated with the significant hierarchical central structures of the autonomic nervous system. They influenced several metabolic/signaling pathways, most notably IP3/Ca++ signaling, the PKA-CREB pathway, and the metabolism of fatty acids. These findings provide new insights into the pathophysiology of NOH in PD and may provide targets for future therapies. Full article

Spinal cord injury (SCI) is a catastrophic event with multiple comorbidities including spastic paralysis, sensory loss, autonomic dysfunction with sympathetic blunting, neurogenic orthostatic hypotension, neurogenic restrictive and obstructive lung disease, neuropathic pain, spasticity, neurogenic bladder, neurogenic bowel, immobilization hypercalcemia, osteopenia/osteoporosis, neurogenic obesity, and metabolic dysfunction. Cervical and thoracic SCI is all too often accompanied by traumatic brain injury (TBI), which carries its own set of comorbidities including headaches, seizures, paroxysmal sympathetic hyperactivity, aphasia, dysphagia, cognitive dysfunction, memory loss, agitation/anxiety, spasticity, bladder and bowel incontinence, and heterotopic ossification. This manuscript will review the etiology and epidemiology of dual diagnoses, assessment of both entities, and discuss some of the most common comorbidities and management strategies to optimize functional recovery. Full article

Background: Symptoms of neurogenic orthostatic hypotension (nOH), including lightheadedness/dizziness, presyncope, syncope, and falls, can lead to impaired functional ability and reduced quality of life. Because the severity and frequency of nOH symptoms fluctuate, it may be difficult for patients to accurately quantify the effect of symptoms on their daily lives using available outcome measures. A new single-item instrument, the ‘Good Day Bad Day,’ was developed, and its psychometric validity was assessed in patients with nOH. Methods: Data from a 6-month, prospective, observational cohort study of patients with nOH who were newly initiating droxidopa treatment were used. Patients were asked to quantify the number of good and bad days in the previous 7 days and responded to other validated patient-reported outcomes instruments. The concurrent and discriminant validities and the stability of the Good Day Bad Day instrument were assessed. Results: A total of 153 patients were included in the analysis (mean [SD] age, 62.3 [17] years). Change in the number of good days moderately correlated with improvements in other patient-reported outcomes (rho value range, −0.38 to −0.61). When data were examined categorically (low vs high symptom severity), the mean number of good days was higher in subgroups representing low symptom severity across measures at 1, 3, and 6 months (all P ≤ 0.01). Conclusions: The Good Day Bad Day instrument provided good discrimination at baseline and over time and may aid in assessment of the effects of nOH symptoms on patients. Full article

Background: We investigated whether changes in the pulse pressure (PP) reduction ratio during the head-up tilt test (HUTT) can aid in distinguishing neurogenic orthostatic hypotension (OH) from non-neurogenic OH. Methods: We enrolled consecutive patients with NOH and non-neurogenic OH between January 2015 and October 2018. We compared the Valsalva ratio, the presence or absence of late phase II and IV overshoot, the pressure recovery time, and the PP reduction ratio during HUTT between the two OH groups. Results: The expiratory–inspiratory (E:I) ratio and Valsalva ratio were significantly decreased in the NOH group (p = 0.026, p < 0.001, respectively). The absence of late phase II and phase IV overshoot was more frequent in the NOH group than in the non-neurogenic OH group (p = 0.001, p < 0.001, respectively). The pressure recovery time was significantly prolonged in the NOH group (p < 0.001), which exhibited increases in the PP reduction ratio (1—minimal PP/baseline PP) during the HUTT (p < 0.001). We calculated the cutoff point for the PP reduction ratio during HUTT, which exhibited an area under the receiver operating characteristic curve of 0.766 (0.659–0.840, 95% confidence interval). The cutoff value for the PP reduction ratio during HUTT (0.571) exhibited sensitivity of 0.879 and specificity of 0.516. Conclusions: Increases in the PP reduction ratio during HUTT may be a meaningful NOH laboratory marker. Full article