The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension.

Autor: Palma JA; Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA. Electronic address: josealberto.palmacarazo@nyulangone.org., Redel-Traub G; Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA., Porciuncula A; Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA., Samaniego-Toro D; Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA; Department of Neurology, Hospital Universitario German Trias i Pujol, Badalona, Barcelona, Spain., Millar Vernetti P; Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA., Lui YW; Division of Neuroradiology, Department of Radiology, New York University School of Medicine, New York, NY, USA., Norcliffe-Kaufmann L; Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA., Kaufmann H; Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA. Electronic address: Horacio.Kaufmann@nyulangone.org.
Jazyk: angličtina
Zdroj: Parkinsonism & related disorders [Parkinsonism Relat Disord] 2020 Jun; Vol. 75, pp. 97-104. Date of Electronic Publication: 2020 May 18.
DOI: 10.1016/j.parkreldis.2020.04.011
Abstrakt: Introduction: In addition to neurogenic orthostatic hypotension (nOH), patients with synucleinopathies frequently have hypertension when supine. The long-term consequences of both abnormalities are difficult to disentangle. We aimed to determine if supine hypertension is associated with target organ damage and worse survival in patients with nOH.
Methods: Patients with nOH due to multiple system atrophy (MSA), Parkinson disease (PD), or pure autonomic failure (PAF) were classified into those with or without supine hypertension (systolic BP of at least 140 mmHg or diastolic BP of at least 90 mmHg). Organ damage was assessed by measuring cerebral white matter hyperintensities (WMH), left ventricular hypertrophy (LVH), and renal function. We prospectively followed patients for 30 months (range: 12-66 months) and recorded incident cardiovascular events and all-cause mortality.
Results: Fifty-seven patients (35 with probable MSA, 14 with PD and 8 with PAF) completed all evaluations. In addition to nOH (average fall 35 ± 21/17 ± 14 mmHg, systolic/diastolic, mean ± SD), 38 patients (67%) had supine hypertension (systolic BP > 140 mmHg). Compared to those without hypertension, patients with hypertension had higher blood urea nitrogen levels (P = 0.005), lower estimated glomerular filtration rate (P = 0.008), higher prevalence of LVH (P = 0.040), and higher WMH volume (P = 0.019). Longitudinal follow-up of patients for over 2 years (27.1 ± 14.5 months) showed that supine hypertension was independently associated with earlier incidence of cardiovascular events and death (HR = 0.25; P = 0.039).
Conclusions: Supine hypertension in patients with nOH was associated with an increased risk for target organ damage, cardiovascular events, and premature death. Defining management strategies and safe blood pressure ranges in patients with nOH remains an important research question.
Competing Interests: Declaration of competing interest J.A.P.: Funding from the NIH, Michael J. Fox Foundation, MSA Coalition, Familial Dysautonomia Foundation, and FDA. He is an advisory Board Member for Takeda, Astellas, Lundbeck, Biogen, PTC Therapeutics and Dr. Reddy's Laboratories; he is the managing editor of Clinical Autonomic Research; and is the principal investigator in clinical trials funded by Theravance Biopharma and Biohaven. G.R.T.: No disclosures. A.P. Funding from the Familial Dysautonomia Foundation. D.S.T.: No disclosures. P.M.V.: No disclosures. Y.W.L: No disclosures. L.N.K: Funding from the NIH, Michael J. Fox Foundation, MSA Coalition, Familial Dysautonomia Foundation, and FDA. Advisory Board Member for PTC Therapeutics. H.K.: Funding from the NIH, Michael J. Fox Foundation, MSA Coalition, Familial Dysautonomia Foundation, and FDA. Advisory Board Member for PTC Therapeutics, Lunbeck, Biogen, Theravance, Biohaven, Eli Lilly, Pfizer, and AstraZeneca; Editor-in-Chief of Clinical Autonomic Research.
(Copyright © 2020 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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