Assessing Frequency of Orthostatic Hypotension in Patients With Parkinson Disease

Frequency of orthostatic hypotension (OH) in Ethiopian patients with Parkinson disease (PD) is higher than in the general population and comparable to other regions, according to study findings published in Ethiopian Journal of Health Sciences.

Considered the most incapacitating nonmotor symptom of PD, OH is highly prevalent among patients with the neurodegnerative condition (45% to 50%) and is an important morbidity factor in the elderly, leading to falls, fractures, and different types of traumas.

With prevalence of PD expected to double by the year 2030, risk of OH has been noted to be of significant importance among these patient populations as it may also be potentially caused by antiparkinsonian medications used to treat PD, such as levodopa and anticholinergic drugs.

Identifying presence of OH in early PD is a major diagnostic challenge as often the alternative diagnosis of multiple system atrophy is usually favored, noted lead study author Abenet Tafesse Mengesha, MD, MSc, associate professor of Neurology, Department of Neurology, College of Health Sciences, Addis Ababa University, in Addis Ababa, Ethiopia.

“Despite frequent occurrence of OH in patients with PD, there are limited well designed controlled studies reported from sub-Saharan Africa, especially in Ethiopia,” he said.

Mengesha conducted a multicenter case-control observational study to determine the frequency and factors associated with OH in individuals diagnosed with PD compared with healthy controls. Eligible patients with PD were treated at neurology clinics at Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital, Yehuleshet Specialty Clinic, and Bethzatha General Hospital between September 2020 and October 2020.

An equal number of patients in age and sex matched PD (n = 53) and non-PD (n = 53) cohorts were included during the study period. All patients with PD were interviewed while attending their regular referral clinic follow-up and the control groups were selected from other patients without PD or attendants present during the study period.

Among the 2 cohorts, mean age distribution was comparable (PD vs non-PD; 61.9 vs 59.9 years) as was distribution of male gender (71.7% vs 67.9%). Mean duration of PD diagnosis was 4.9 (3.4) years, and a majority of the patients with PD were in the early disease stage (Hoehn and Yahr scale stage 1 and 2).

Nearly all the individuals diagnosed with PD were indicated to be on levodopa treatment, and close to half of them were on anticholinergic drugs. Hypertension was the most common comorbid disorder in the PD group (24.5%) and the control group (7.5%).

Findings showed the prevalence of OH was higher in PD patients (22.6%) compared with the control group (9.4%). A near-significant association was found between OH and PD diagnosis compared with the healthy control group (11.3% vs 4.7%; P = .06). No difference was observed between the 2 groups regarding age category and sex, but the trend of OH was higher among older patients with PD compared with the healthy control group.

The PD group reported a higher proportion of several clinical features of autonomic impairment vs the control group: constipation (P = .007), urinary urgency (P = .007), and nocturia (P < .0001). Falls and excessive sweating were only reported by patients with PD.

Mengesha concluded that larger prospective studies are warranted to consolidate the present study findings.

Reference

Mengesha AT. Frequency and factors associated with orthostatic hypotension in individuals with Parkinson's disease: a case-control observational study. Ethiop J Health Sci. 2022 Nov;32(6):1167-1174. doi:10.4314/ejhs.v32i6.14