24-HOUR BLOOD-PRESSURE PROFILE AND BLOOD-PRESSURE RESPONSES TO HEAD-UP TILT TESTS IN PARKINSONS-DISEASE AND MULTIPLE SYSTEM ATROPHY

Objective To investigate the 24 h blood pressure profile in patients w ith Parkinson's disease with intact autonomic function or with autonom ic failure and patients with multiple system atrophy (MSA), and to ass ess whether these patients exhibit posture-related variations in blood pressure. Patients and methods We studied 24 patients with Parkinson' s disease (11 with autonomic failure) and 13 patients with MSA (all wi th autonomic failure). Autonomic failure was determined by autonomic t ests. An oscillometric recorder was used for ambulatory blood pressure monitoring. Tilt-table tests were performed with a head-up tilt posit ion of 60 degrees. Results An alteration in the normal 24 h blood pres sure profile was observed in 82% of Parkinson's disease patients with autonomic failure and in 85% of those with multiple system atrophy, bu t not in the patients with intact autonomic function. Head-up tilt tes ts revealed a significantly higher supine blood pressure in Parkinson' s disease patients with autonomic failure and in those with MSA than i n Parkinson's disease patients with intact autonomic function. Tilting resulted in a marked fall in blood pressure in patients with MSA; in Parkinson's disease patients with autonomic failure, the fall was comp aratively slighter. Conclusions We conclude that autonomic failure con tributes to the alterations in the day-night blood pressure profile th at may possibly be ascribed to postural dysregulation of blood pressur e. We hypothesize that nocturnal hypertension is a risk factor in the development of additional cerebrovascular disease in patients with Par kinson's disease or MSA who are affected by autonomic failure. (C) 199 8 Lippincott Williams & Wilkins.