ABSTRACT
Parkinson′s disease (PD) is the second most common neurodegenerative disease following Alzheimer′s disease, including motor and non-motor symptoms. Non-motor symptoms are mainly autonomic nervous dysfunction, which occur about 5-20 years earlier than motor symptoms. Abnormal blood pressure regulation is a common manifestation of autonomic nervous dysfunction. Long-term abnormal blood pressure can seriously hamper the quality of life and trigger deterioration of motor symptoms. Thus, it is necessary to obtain correct understanding of the etiology, mechanism, clinical features, diagnosis and treatment of PD with blood pressure regulation disorders in order to reduce the mortality rate and the burden of medical health. This article reviews the influencing factors, characteristics, mechanisms and management of PD with blood pressure regulation disorder.
ABSTRACT
Parkinson′s disease (PD) is the second most common neurodegenerative disease following Alzheimer′s disease, including motor and non?motor symptoms. Non?motor symptoms are mainly autonomic nervous dysfunction,which occur about 5-20 years earlier than motor symptoms. Abnormal blood pressure regulation is a common manifestation of autonomic nervous dysfunction. Long?term abnormal blood pressure can seriously hamper the quality of life and trigger deterioration of motor symptoms. Thus, it is necessary to obtain correct understanding of the etiology, mechanism, clinical features, diagnosis and treatment of PD with blood pressure regulation disorders in order to reduce the mortality rate and the burden of medical health. This article reviews the influencing factors,characteristics,mechanisms and management of PD with blood pressure regulation disorder.
ABSTRACT
Objective To investigate the correlation of the supine hypertension (SP) with carotid intima-media thickness (IMT) in the elderly. Methods Kailuan study is a functional community-based cardiovascular risk factor study. From June 2006, there was a physical examination every two years. In the examination, demographic data, smoking, drinking, physical exercise situation and medication situation were recorded. Levels of triglyceride, high sensitivity C-reactive protein, low density lipoprotein and other biochemical indexes were observed. Using cluster random sampling, 3 064 retired employees of 60 years of age or older were selected. A total of 2 464 subjects took part in an additional examination, including the 24-hour ambulatory blood pressure monitoring, brachial-ankle pulse wave velocity, blood pressure of different positions and urine albumin. Multiple linear regression was used to analyze the correlation between supine systolic blood pressure (SBP) and IMT. Multivariate Logistic regression was used to analyze the effect of SP on IMT. Results (1) Among 2 220 participants (67.29±6.09) years, 1 463 (65.9%) individuals were male and 757 (34.1%) were females, and the average IMT was (0.92 ± 0.18) mm. (2) There was a positive correlation between supine SBP and IMT (r=0.175, P<0.01). (3) After adjusting the confounds, supine SBP was significantly associated with IMT, with an increase of 1 SD (+20.42 mmHg, 1 mmHg=0.133 kPa) in SBP corresponding to an increase of IMT by 0.01 mm (P<0.01). (4) Multiple Logistic regression analysis showed that after adjusting for sitting SBP, age, gender and other factors, SP was still a risk factor of increased IMT (OR=1.37, 95%CI:1.03-1.80), and independent of sitting SBP. Conclusion The supine hypertension is a risk factor of increased IMT, and independent of sitting SBP.
ABSTRACT
Orthostatic hypotension (OH) occurs when mechanisms for the regulation of orthostatic BP control fails. Such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. OH is common in the elderly and is associated with an increase in mortality rate. There are many causes of OH. Aging coupled with diseases such as diabetes and Parkinson's disease results in a prevalence of 10-30% in the elderly. These conditions cause baroreflex failure with resulting combination of OH, supine hypertension, and loss of diurnal variation of BP. The treatment of OH is imperfect since it is impossible to normalize standing BP without generating excessive supine hypertension. The practical goal is to improve standing BP so as to minimize symptoms and to improve standing time in order to be able to undertake orthostatic activities of daily living, without excessive supine hypertension. It is possible to achieve these goals with a combination of fludrocortisone, a pressor agent (midodrine or droxidopa), supplemented with procedures to improve orthostatic defenses during periods of increased orthostatic stress. Such procedures include water bolus treatment and physical countermaneuvers. We provide a pragmatic guide on patient education and the patient-orientated approach to the moment to moment management of OH.