Blood Pressure Linked With Fall Risk in Patients With Parkinson Disease

People with Parkinson disease (PD) were found to be more likely than those without the condition to have orthostatic hypotension, a sudden drop in blood pressure (BP) upon standing, according to study findings published today in Neurology.

The drop in BP that characterizes orthostatic hypotension can lead to dizziness and lightheadedness, as well as falls and fainting, notes study author Alessandra Fanciulli, MD, PhD, of the Medical University of Innsbruck in Austria, in the accompanying press release.

Among elderly adults, falls are common, affecting 19% to 49% of the general population. Moreover, falls can prove dangerous for older populations, with patients with PD (PwP) at an even greater risk due to both motor and nonmotor symptoms.

"If we can monitor people's blood pressure to detect this condition, we could potentially control these blood pressure drops and prevent some of the falls that can be so damaging for people with PD," said Fanciulli.

Fanciulli and colleagues sought to assess the frequency of transient orthostatic hypotension (tOH) and its clinical impact in PD. They recruited 173 PwP who had been referred for testing for autonomic problems that can cause dizziness and fainting and 173 age- and gender-matched controls with orthostatic intolerance, a syndrome characterized by the development of symptoms when standing upright that are relieved when lying down.

The researchers screened each person’s BP for 2 types of orthostatic hypotension: tOH (systolic BP fall ≥ 20 mm Hg or diastolic BP ≥ 10mm Hg resolving within the first minute upon standing), which occurs when BP falls dramatically upon rising from sitting or lying down and then goes back to normal within a minute, and classic orthostatic hypotension (cOH) (sustained systolic BP fall ≥ 20 mm Hg or diastolic BP ≥ 10 mm Hg within 3 minutes upon standing), in which BP drops within 3 minutes after standing and then returns to normal.

They also reviewed the medical records of PwP for the 6 months preceding and following autonomic testing for history of falls, syncope, and orthostatic intolerance.

In their findings, 19% of PwP were revealed to have cOH, which was not found among any patients of the control group. In assessing prevalence of tOH, 24% of PwP and 21% of those with orthostatic intolerance were found to have the condition. After adjusting for factors that may influence BP drop, PwP were indicated by researchers as being twice as likely to have the condition than the control matched group.

Additionally, 40% of PwP were shown to have a history of falls based on medical records, with 29% of falls caused by fainting.

“tOH is an age-dependent phenomenon, which is at least as common as cOH in PD. Transient BP falls when changing to the upright position may be overlooked with bedside BP measurements, but contribute to orthostatic intolerance and syncope in PD,” concludes the study authors. “Continuous non-invasive BP monitoring upon standing may help identify a modifiable risk factor for syncope-related falls in parkinsonian patients.”

Reference

Fanciulli A, Campese N, Goebel G, et al. Association of transient orthostatic hypotension with falls and syncope in patients with Parkinson disease. Neurology. Published online September 16, 2020. doi:10.1212/WNL.0000000000010749