J Parkinsons Dis. 2026 Jun 4:1877718X261457798. doi: 10.1177/1877718X261457798. Online ahead of print.
ABSTRACT
BackgroundOrthostatic hypotension (OH) and supine hypertension (SH) are common in patients with Parkinson's disease (PD), contributing to disease-related morbidity and mortality. However, initial OH, a transient blood pressure that decreases immediately after standing, is often unrecognized, and the interactions among OH, SH, and anti-hypertensive therapy remain unclear.MethodsThis single-centre retrospective observational study included 183 patients with PD who underwent an active supine-to-stand test with beat-to-beat blood pressure monitoring. Logistic regression was used to identify factors associated with OH and SH, and linear regression was performed to examine the determinants of postural blood pressure decline and changes in cerebral haemodynamics.ResultsOH occurred in 72.1% of patients, including 27.9% with symptomatic OH; SH was present in 21.9%. Female sex (P = 0.013) and anti-hypertensive therapy (P = 0.026) were associated with lower odds of OH. Older age (P = 0.017), arterial hypertension (P = 0.002), and a high Hoehn and Yahr stage (P = 0.006) were associated with higher odds of SH (AUC 0.80). Increased supine systolic and diastolic blood pressure were associated with increased postural decline (β = 0.40, P < 0.001; β = 0.31, P = 0.001), whereas anti-hypertensive therapy was associated with decreased postural decline. Among patients with complete middle cerebral artery monitoring data, changes in the pulsatility index were correlated with reductions in cerebral blood flow velocity (β = -11.24; P = 0.002).ConclusionsThis study comprehensively characterized the prevalence and determinants of OH and SH in patients with PD. SH was associated with greater decreases in postural blood pressure, whereas anti-hypertensive therapy was associated with smaller decreases. Pulsatility index variation may serve as a physiological marker of cerebral haemodynamic adaptation during an orthostatic challenge.
PMID:42240302 | DOI:10.1177/1877718X261457798