Are current recommendations to diagnose orthostatic hypotension in Parkinson's disease satisfactory?

Authors

  • Jenny Jamnadas-Khoda BMedSci,

    1. School of Health and Related Research, Sheffield University, Sheffield, United Kingdom
    Search for more papers by this author
  • Suma Koshy BSC,

    1. Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
    Search for more papers by this author
  • Christopher J. Mathias DSC,

    1. Neurovascular Medicine Unit, St. Mary's Hospital, Imperial College London, London, United Kingdom
    2. Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square and Institute of Neurology, University College London, London, United Kingdom
    Search for more papers by this author
  • Uday B. Muthane DM,

    Corresponding author
    1. Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
    • Parkinson's & Ageing Research Foundation, Specialist Clinic, # 37, SBI Road, Bangalore 560 001, India
    Search for more papers by this author
  • Mona Ragothaman MBBS,

    1. Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
    Search for more papers by this author
  • Subbakrishna K. Dodaballapur PhD

    1. Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
    Search for more papers by this author

  • Potential conflict of interest: None reported.

Abstract

We interviewed 50 Parkinson's disease (PD) patients using a questionnaire to verify the reliability of orthostatic symptoms in warning the presence of orthostatic hypotension (OH). OH is defined as 20 mm Hg systolic or 10 mm Hg diastolic BP fall within 3 min of tilting or standing but if this fall occurs after 3 min we called it ‘late OH’ (L-OH). We compared if OH in Parkinson's disease (PD) was more frequent after head-up tilt or on standing and if the period of postural challenge matters in detecting OH. Twenty-one (42%) patients had OH that occurred twice more often after tilting (n = 20) than on standing (n = 10). OH occurred within 3 min of tilting in 9 patients (18%) and appeared beyond the currently recommended 3 min in 11 patients (55%) (L-OH). Ten of the 20 patients developing OH on tilting were symptomatic. The 10 patients who had OH on standing were asymptomatic. Reporting of symptoms was independent of age or severity of BP fall. Most (90%) patients reporting orthostatic symptoms on standing had OH on tilting for 3 min. Orthostatic symptoms in PD have a high specificity but low sensitivity in predicting OH. In Parkinson's disease OH occurs often after tilting than on standing and is delayed (after 3 min). As OH in PD is often asymptomatic and delayed it could contribute to falls and increase morbidity. We suggest routine evaluation of OH in PD by tilting them longer than the recommended 3 minutes to detect delayed OH. © 2009 Movement Disorder Society

Ancillary