医学
仰卧位
直立生命体征
无症状的
倾斜试验台
内科学
膀胱过度活动
物理疗法
队列
血压
体质指数
心率
病理
替代医学
作者
Kai Bin Lim,Shen‐Yang Lim,Jia Wei Hor,Heamah Krishnan,Firdaus Mortadza,Jia Lun Lim,Karuthan Chinna,Nor Izzati Saedon,Ai Huey Tan
标识
DOI:10.1016/j.parkreldis.2024.106980
摘要
ABSTRACT
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 OH in PD.
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