Blood pressure circadian rhythm alterations in alpha-synucleinopathies
We sought to analyze the blood pressure (BP) circadian rhythm in Parkinson’s disease (PD), multiple system atrophy (MSA), and pure autonomic failure (PAF) and to evaluate the effect of vasoactive and dopaminergic medications on BP fluctuations during activities of daily living.
We analyzed data from patients with PD (n = 72), MSA (n = 18), and PAF (n = 17) evaluated with 24-h ambulatory BP monitoring (ABPM) at our Center between 1996 and 2015. Comparisons between groups were performed according to (a) clinical diagnosis and (b) pharmacological treatment. ABPM parameters included 24-h BP variability, BP load, nocturnal dipping, and awakening hypotension.
The average BP was 121 ± 14/72 ± 8 mmHg during daytime and 133 ± 20/76 ± 13 mmHg during nighttime (p < 0.01), with BP load of 24 ± 22/15 ± 16% (daytime) vs. 61 ± 36/52 ± 36% (nighttime) (p < 0.01). In-office BP measurements were consistent with OH in 95 patients (89%) and SH in 63 (59%). ABPM demonstrated increased BP variability in 67 patients (63%), awakening hypotension in 63 (59%), “reverse dipping” in 85 (79.4%), “reduced dipping” in 13 (12.1%), and “normal dipping” in 9 (8.4%). No differences were observed between PD, MSA, and PAF, but a sub-analysis of PD patients revealed two distinct patterns of BP alterations. No significant differences were observed in relation to the use of vasoactive or dopaminergic medications.
Regardless of the neurological diagnosis and pharmacological treatment, patients with alpha-synucleinopathies showed a BP circadian rhythm characterized by increased BP variability, reverse dipping, increased BP load, and awakening hypotension.
KeywordsCardiovascular autonomic neuropathy Ambulatory blood pressure monitoring Reverse dipping Blood pressure variability Orthostatic hypotension.
Authors acknowledge the contributions of the Autonomic and Hypertension Unit staff.
Compliance with ethical standards
Conflicts of interest
Fabrizio Vallelonga reports no disclosures. Cristina Di Stefano reports no disclosures. Aristide Merola is supported by NIH (KL2 TR001426) and has received speaker honoraria from CSL Behring, Abbvie, and Cynapsus Therapeutics. He has received grant support from Lundbeck and Abbvie and personal compensation from Lundbeck, Abbvie, and Abbott. Alberto Romagnolo has received grant support and speaker honoraria from AbbVie, speaker honoraria from Chiesi Farmaceutici and travel grants from Lusofarmaco and UCB Pharma. Gabriele Sobrero reports no disclosures. Valeria Milazzo reports no disclosures. Alessio Burrello reports no disclosures. Jacopo Burrello reports no disclosures. Maurizio Zibetti has received speaker’s honoraria from Medtronic, Chiesi Farmaceutici, UCB Pharma, and AbbVie. Franco Veglio reports no disclosures. Simona Maule reports no disclosures.
The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. The local institutional review board (Comitato Etico Interaziendale Città della Salute e della Scienza di Torino) approved the study and all participants provided written informed consent.
- 1.Mathias CJ (2003) Autonomic diseases: clinical features and laboratory evaluation. J Neurol Neurosurg Psychiatry 74(Suppl 3):iii31–i41Google Scholar
- 6.Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Durr A, Fowler CJ, Kaufmann H, Klockgether T, Lees A, Poewe W, Quinn N, Revesz T, Robertson D, Sandroni P, Seppi K, Vidailhet M (2008) Second consensus statement on the diagnosis of multiple system atrophy. Neurology 71:670–676CrossRefGoogle Scholar
- 9.Novak P (2011) Quantitative autonomic testing. J Vis Exp 19;(53):pii 2502Google Scholar
- 11.Fanciulli A, Jordan J, Biaggioni I et al (2018) Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS): endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH). Clin Auton Res. https://doi.org/10.1007/s10286-018-0529-8 Google Scholar
- 14.Mancia G, Fagard R, Narkiewicz K et al (2013) ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34:2159–2219CrossRefGoogle Scholar
- 19.Fanciulli A, Strano S, Ndayisaba JP, Goebel G, Gioffrè L, Rizzo M, Colosimo C, Caltagirone C, Poewe W, Wenning GK, Pontieri FE (2014) Detecting nocturnal hypertension in Parkinson’s disease and multiple system atrophy: proposal of a decision-support algorithm. J Neurol 261:1291–1299CrossRefGoogle Scholar
- 31.Schillaci G, Bilo G, Pucci G, Laurent S, Macquin-Mavier I, Boutouyrie P, Battista F, Settimi L, Desamericq G, Dolbeau G, Faini A, Salvi P, Mannarino E, Parati G (2012) Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases. Hypertension 60:369–377CrossRefGoogle Scholar
- 44.Gibbons CH, Schmidt P, Biaggioni I, Frazier-Mills C, Freeman R, Isaacson S, Karabin B, Kuritzky L, Lew M, Low P, Mehdirad A, Raj SR, Vernino S, Kaufmann H (2017) The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 264:1567:1582CrossRefGoogle Scholar
- 45.Jordan J, Shannon JR, Pohar B, Paranjape SY, Robertson D, Robertson RM, Biaggioni I (1999) Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure. J Am Soc Nephrol 10:35–42Google Scholar