Lim, Kai Bin and Lim, Shen Yang and Krishnan, Heamah and Mortadza, Firdaus and Lim, Jia Lun and Chinna, Karuthan and Saedon, Nor Izzati and Tan, Ai Huey (2024) Orthostatic hypotension in Parkinson's disease: Sit-to-stand vs. supine-to-stand protocol and clinical correlates. Parkinsonism & Related Disorders, 123. p. 106980. ISSN 1353-8020, DOI https://doi.org/10.1016/j.parkreldis.2024.106980.
Full text not available from this repository.Abstract
Background: Screening for orthostatic hypotension (OH) is integral in Parkinson's disease (PD) management, yet evidence-based guidelines on best practice methods for diagnosing OH in PD are lacking. Methods: We investigated the frequency and correlates of OH, symptomatic OH, and neurogenic OH, in a large consecutively recruited PD cohort (n = 318), and compared the diagnostic performance of the sit-to-stand vs. the supine-to-stand blood pressure (BP) test. We evaluated the utility of continuous BP monitoring and tilt table testing in patients with postural symptoms or falls who were undetected to have OH with clinic-based BP measurements. Disease severity, fluid intake, orthostatic and overactive bladder symptoms, falls, comorbidities and medication history were evaluated. Results: Patients' mean age was 66.1 +/- 9.5years, with mean disease duration 7.8 +/- 5.5years. OH frequency was 35.8 % based on the supine-to-stand test. OH in PD was significantly associated with older age, lower body mass index, longer disease duration, worse motor, cognitive and overactive bladder symptoms and functional disabilities, falls, and lower fluid intake. A similar profile was seen with asymptomatic OH. Three quarters of OH were neurogenic, with the majority also having supine hypertension. The sit-to-stand test had a sensitivity of only 0.39. One quarter of patients were additionally diagnosed with OH during continuous BP monitoring. Conclusions: The sit-to-stand test substantially underdiagnoses OH in PD, with the important practice implication that supine-to-stand measurements may be preferred. Screening for OH is warranted even in asymptomatic patients. Adequate fluid intake, treatment of urinary dysfunction and falls prevention are important strategies in managing PD patients with OH.
| Item Type: | Article |
|---|---|
| Funders: | University of Malaya Parkinson's Disease and Movement Disorders Research Program, University of Malaya Faculty of Medicine PERINTIS Program (PV035-2017) |
| Uncontrolled Keywords: | Orthostatic hypotension; Neurogenic orthostatic hypotension; Sit-to-stand blood pressure; Continuous blood pressure monitoring; Tilt table; Falls; Autonomic dysfunction |
| Subjects: | R Medicine |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 20 Sep 2024 04:36 |
| Last Modified: | 20 Sep 2024 04:36 |
| URI: | http://eprints.um.edu.my/id/eprint/45167 |
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