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Multicenter Study
. 2025 Jul 1;54(7):afaf187.
doi: 10.1093/ageing/afaf187.

Delayed orthostatic hypotension in Parkinson's disease and in the general ageing population

Bianca Calió  1 , Fabian Leys  1 , Giulia Matteucci  2 , Nicole Campese  1 , Giulia Rivasi  2 , Georg Göbel  3 , Giuseppe Dario Testa  2 , Roberta Granata  1 , Susanne Dürr  1 , Jean-Pierre Ndayisaba  1 , Karoline Radl  1 , Michael Thurner-Rodriguez  1 , Klaus Seppi  1 , Werner Poewe  1 , Stefan Kiechl  1 , Andrea Ungar  2 , Gregor Wenning  1 , Martina Rafanelli  2 , Alessandra Fanciulli  1
Affiliations
Multicenter Study

Delayed orthostatic hypotension in Parkinson's disease and in the general ageing population

Bianca Calió et al. Age Ageing. .

Abstract

Objective: Delayed orthostatic hypotension (dOH) is defined by a sustained blood pressure (BP) fall ≥20/10 mmHg occurring beyond 3 minutes in the upright position, whose clinical relevance is yet undetermined. We investigated frequency, associated features and treatment strategies of dOH in Parkinson's Disease (PD) and ageing individuals with history of syncope or orthostatic intolerance.

Methods: We retrospectively studied 213 individuals with PD and 213 age-matched individuals without parkinsonism referred for tilt-table testing to the Innsbruck and Florence Dysautonomia centres. In both cohorts, we reviewed the medical records of the 6 months before testing for history of syncope and falls, and of the 6 months afterwards for the recommended dOH treatment and clinical outcome.

Results: dOH was twice as frequent in PD than in ageing individuals [18% versus 9%; OR = 2.9 (95 CI.: 1.3-6.5), P = .007]. Upon prolonged head-up tilt, PD individuals showed a more severe systolic BP fall (P < .001). PD individuals with history of syncope also exhibited a sustained systolic BP fall from the 3rd minute of head-up tilt onward compared to those without (P = .014). Both non-pharmacological and pharmacological OH treatment strategies were associated with symptomatic improvement at follow-up.

Conclusions: In PD individuals referred to tertiary settings, tilt-table testing more frequently disclosed dOH compared to age-matched individuals without parkinsonism. In PD, dOH is mainly driven by a progressive orthostatic systolic BP fall, increasing the risk of syncope. Given its prevalence and the potential for effective treatment, dOH should be actively screened for in clinical practice.

Keywords: Parkinson’s disease; ageing population; delayed orthostatic hypotension; falls; older people; syncope.

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Conflict of interest statement

J-P.N. reports Honoria from the Austrian Autonomic Society, the Austrian Parkinson Society, outside of the present work.

K.S. KS reports honoraria from the International Parkinson and Movement Disorders Society, grants from the FWF Austrian Science Fund, the Michael J. Fox Foundation, and the International Parkinson and Movement Disorder Society, as well as personal fees from Teva, UCB, Lundbeck, AOP Orphan Pharmaceuticals AG, AbbVie, Roche, and Grünenthal, outside the submitted work.

W.P. reports personal fees from Alterity, AbbVie, AC-Immune, AstraZeneca, BIAL, Biogen, Britannia, Lilly, Lundbeck, Neuroderm, Roche, Takeda, Teva, UCB and Zambon in relation to consultancy around clinical drug development programmes for PD and MSA, outside of the present work.

M.R. reports speaker fees from Boston Scientific.

A.F. reports royalties from Springer Verlag, speaker fees and honoraria from Bial, CNSystems, Elsevier, Theravance Biopharma, Medtronic, Sanofi, Austrian Autonomic Society, Austrian Neurology Society, International Parkinson Disease and Movement Disorders Society, Elsevier and research grants from the FWF-Austrian Science Fund, Medical University of Innsbruck, Mission MSA and Dr Johannes and Hertha Tuba Foundation, outside of the present work.

Figures

Figure 1
Figure 1
(a) Frequency of cOH and dOH in PD and ageing individuals; (b) ANOVA of HR, systolic and diastolic BP upon 10 minutes head-up tilt test in PD and ageing individuals. In the supine position, PD individuals had significantly higher HR [67 (61; 76) vs. 63 (57; 70) bmp, P = .002] and diastolic BP values [77 (69; 86) vs. 74 (65; 82) P ≤ .001]. Upon 10 minutes of head-up tilt-test, PD individuals showed a moderate, yet significantly higher HR increase [+8 (+3; +12) vs. + 6 (+2; +10) bpm, P = .003], a smaller increase in diastolic BP [+1 (−7; +7) vs. 8 (−3; +11) mmHg, P ≤ .001] and a fall in systolic BP [−4 (−15;+6) vs. +4 (−9; +13) mmHg, P ≤ .001] compared to ageing individuals. Created with Microsoft PowerPoint 2016.
Figure 2
Figure 2
Frequency of pathological cardiovascular autonomic function indices in the PD cohort. Among the 131 individuals with PD who performed a deep breathing, 18 exhibited cOH, 13 dOH and 76 no OH upon head-up tilt test. A Valsalva manoeuvre was conducted in 107 individuals with PD, including 23 with cOH, 19 with dOH and 89 without OH. Created with Microsoft PowerPoint 2016.
Figure 3
Figure 3
ANOVA of HR, systolic and diastolic BP measured upon head-up tilt test in PD and age-matched individuals without parkinsonism with positive versus negative history of syncope (upper panel) and falls (lower panel). Created with Microsoft PowerPoint 2016.
See this image and copyright information in PMC

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