期刊
JOURNAL OF THE NEUROLOGICAL SCIENCES
卷 310, 期 1-2, 页码 123-128出版社
ELSEVIER
DOI: 10.1016/j.jns.2011.06.047
关键词
Parkinson; Supine hypertension; Orthostatic hypotension; Baroreflex; Blood pressure; Autonomic
资金
- Intramural NIH HHS [Z99 NS999999, Z01 NS003033-01] Funding Source: Medline
Non-motor aspects of Parkinson disease (PD) are now recognized to be important both clinically and scientifically. Among these facets are abnormalities in blood pressure regulation. As much as 40% of PD patients have orthostatic hypotension (OH), which is usually associated with supine hypertension (SH). Symptoms of OH range from light-headedness to falls with serious trauma. SH, while typically asymptomatic, poses a significant increased risk for cardiovascular morbidity and mortality. Neuroimaging, neurochemical, and neuropharmacological studies indicate cardiac and extra-cardiac sympathetic noradrenergic denervation and baroreflex failure in virtually all PD patients with OH, and cardiac sympathetic denervation has been confirmed histopathologically. Mechanisms of SH in PD + OH remain poorly understood. The diurnal blood pressure profile shows increased variability that is correlated with decreased baroreflex gain and with increased morbidity and mortality. Treatment should be individually tailored according to the timing of OH or SH, using primarily short-acting sympathomimetic medications in the daytime for OH and short-acting antihypertensive in the nighttime for SH. Future research is needed to understand better and attenuate blood pressure fluctuations through manipulations that improve baroreflex function. (C) 2011 Elsevier B.V. All rights reserved.
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