背景:体位性低血压(OH)筛查是帕金森病(PD)治疗中不可或缺的一部分,然而,缺乏关于诊断PD中OH的最佳实践方法的循证指南。
方法:我们研究了OH,有症状的OH,和神经源性OH,在一个大型连续招募的PD队列(n=318)中,并比较了坐姿与坐姿的诊断性能仰卧位血压(BP)测试。我们评估了连续BP监测和倾斜台测试在有姿势症状或跌倒的患者中的实用性,这些患者通过基于临床的BP测量未发现OH。疾病严重程度,液体摄入,直立和膀胱过度活动症状,falls,评估合并症和用药史。
结果:患者的平均年龄为66.1±9.5岁,平均病程7.8±5.5年。基于仰卧位测试,OH频率为35.8%。PD中的OH与年龄显着相关,较低的体重指数,疾病持续时间较长,更坏的电机,认知和膀胱过度活动症症状和功能障碍,falls,和较低的液体摄入量。无症状OH也有类似的情况。四分之三的OH是神经源性的,大多数人还患有仰卧高血压。坐立测试的灵敏度仅为0.39。在连续BP监测期间,四分之一的患者被诊断为OH。
结论:坐姿测试在PD中大大低估了OH,具有重要的实践意义,即仰卧位测量可能是首选。即使在无症状患者中,也有必要进行OH筛查。充足的液体摄入,泌尿功能障碍的治疗和跌倒预防是治疗患有OH的PD患者的重要策略。
BACKGROUND: Screening for orthostatic hypotension (OH) is integral in Parkinson\'s disease (PD) management, yet evidence-based guidelines on best practice methods for diagnosing OH in PD are lacking.
METHODS: We investigated the frequency and correlates of OH, symptomatic OH, and neurogenic OH, in a large consecutively recruited PD cohort (n = 318), and compared the diagnostic performance of the sit-to-stand vs. the supine-to-stand blood pressure (BP) test. We evaluated the utility of continuous BP monitoring and tilt table testing in patients with postural symptoms or falls who were undetected to have OH with clinic-based BP measurements. Disease severity, fluid intake, orthostatic and overactive bladder symptoms, falls, comorbidities and medication history were evaluated.
RESULTS: Patients\' mean age was 66.1 ± 9.5years, with mean disease duration 7.8 ± 5.5years. OH frequency was 35.8 % based on the supine-to-stand test. OH in PD was significantly associated with older age, lower body mass index, longer disease duration, worse motor, cognitive and overactive bladder symptoms and functional disabilities, falls, and lower fluid intake. A similar profile was seen with asymptomatic OH. Three quarters of OH were neurogenic, with the majority also having supine hypertension. The sit-to-stand test had a sensitivity of only 0.39. One quarter of patients were additionally diagnosed with OH during continuous BP monitoring.
CONCLUSIONS: The sit-to-stand test substantially underdiagnoses OH in PD, with the important practice implication that supine-to-stand measurements may be preferred. Screening for OH is warranted even in asymptomatic patients. Adequate fluid intake, treatment of urinary dysfunction and falls prevention are important strategies in managing PD patients with OH.