Journal of Neurology

, Volume 266, Issue 5, pp 1141–1152 | Cite as

Blood pressure circadian rhythm alterations in alpha-synucleinopathies

  • Fabrizio VallelongaEmail author
  • Cristina Di Stefano
  • Aristide Merola
  • Alberto Romagnolo
  • Gabriele Sobrero
  • Valeria Milazzo
  • Alessio Burrello
  • Jacopo Burrello
  • Maurizio Zibetti
  • Franco Veglio
  • Simona Maule
Original Communication



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.


Cardiovascular 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.

Ethical standard

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.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fabrizio Vallelonga
    • 1
    Email author
  • Cristina Di Stefano
    • 1
  • Aristide Merola
    • 2
  • Alberto Romagnolo
    • 3
  • Gabriele Sobrero
    • 1
  • Valeria Milazzo
    • 1
  • Alessio Burrello
    • 4
  • Jacopo Burrello
    • 1
  • Maurizio Zibetti
    • 3
  • Franco Veglio
    • 1
  • Simona Maule
    • 1
  1. 1.Autonomic Unit and Hypertension Unit, Department of Medical SciencesUniversity of TurinTurinItaly
  2. 2.Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiUSA
  3. 3.Department of Neuroscience “Rita Levi Montalcini”University of TurinTurinItaly
  4. 4.Department of Electronics and TelecommunicationsPolytechnic University of TurinTurinItaly

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