Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson's disease

Fabrizio Vallelonga; Matteo Valente; Marta Maria Tangari; Anna Covolo; Valeria Milazzo; Cristina Di Stefano; Gabriele Sobrero; Marta Giudici; Alberto Milan; Franco Veglio; Leonardo Lopiano; Simona Maule; Alberto Romagnolo

doi:10.1007/s10286-024-01030-7

Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson's disease

Clin Auton Res. 2024 Apr 25. doi: 10.1007/s10286-024-01030-7. Online ahead of print.

Authors

Fabrizio Vallelonga^#^{1

2

3}, Matteo Valente^#⁴, Marta Maria Tangari⁵, Anna Covolo⁵, Valeria Milazzo⁴, Cristina Di Stefano⁴, Gabriele Sobrero⁴, Marta Giudici⁴, Alberto Milan^{6

7

4}, Franco Veglio⁴, Leonardo Lopiano⁵, Simona Maule^#⁴, Alberto Romagnolo^#⁵

Affiliations

¹ Division of Internal Medicine, Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142, Km 3,95, Candiolo, 10060, Turin, Italy. fabrizio.vallelonga@unito.it.
² Department of Medical Science, University of Turin, Turin, Italy. fabrizio.vallelonga@unito.it.
³ Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy. fabrizio.vallelonga@unito.it.
⁴ Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
⁵ Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
⁶ Division of Internal Medicine, Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142, Km 3,95, Candiolo, 10060, Turin, Italy.
⁷ Department of Medical Science, University of Turin, Turin, Italy.

^# Contributed equally.

PMID: 38662269
DOI: 10.1007/s10286-024-01030-7

Abstract

Purpose: Neurogenic orthostatic hypotension (nOH) is a frequent nonmotor feature of Parkinson's disease (PD), associated with adverse outcomes. Recently, 24-h ambulatory blood pressure monitoring (ABPM) showed good accuracy in diagnosing nOH. This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to the well-defined prognostic role of bedside nOH.

Methods: Patients with PD who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, and mortality, during an up-to-10-year follow-up. Significant ABPM-hypotensive episodes were identified when greater than or equal to two episodes of systolic BP drop ≥ 15 mmHg (compared with the average 24 h) were recorded during the awakening-to-lunch period.

Results: A total of 99 patients (74% male, age 64.0 ± 10.1 years, and PD duration 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH. On Kaplan-Meier analysis, patients with ABPM-hypotensive episodes showed earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and shorter survival (8.0 versus 9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and Hoehn and Yahr stage) a significant association was confirmed between ABPM-hypotensive episodes and falls [odds ratio (OR) 3.626; p = 0.001), hospitalizations (OR 2.016; p = 0.038), and dementia (OR 2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR 1.908; p = 0.048).

Conclusions: The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.

Keywords: Adverse outcomes; Ambulatory blood pressure monitoring; Disability milestones; Hypotensive episodes; Orthostatic hypotension; Parkinson’s disease.