Objective: To analyze the blood pressure (BP) circadian rhythm in Parkinson’s disease (PD), multiple system atrophy (MSA), and pure autonomic failure (PAF), evaluating possible differences among the three synucleinopathies.

Background: Previous studies reported that 24-h ambulatory blood pressure monitoring (ABPM) might capture the circadian BP alterations associated with cardiovascular autonomic neuropathy (CAN) in PD [1], supporting the role of ABPM in the diagnosis and follow-up of CAN. Data currently available fail to clarify the extent to which ABPM alterations are differentially represented in PD, MSA and PAF, as well as the impact of vasoactive and dopaminergic medications on the circadian BP profile.

Method: BP circadian rhythm of patients with PD (n=72), MSA (n=18), and PAF (n=17) was assessed by means of ABPM. ABPM parameters included BP variability (BPV), BP load, nocturnal dipping, awakening hypotension. An unsupervised cluster analysis was performed to evaluate possible distinct patterns of BP alterations in PD

Results: The average BP was 121±14/72±8 mmHg (daytime) vs 133±20/76±13 mmHg (nighttime) (p<0.01), with BP load of 24±22/15±16% (daytime) vs 61±36/52±36% (nighttime) (p<0.01). Orthostatic hypotension (OH) was present in 95 patients (89%), supine hypertension (SH) in 63 (59%). Increased BPV was present in 67 patients (63%), awakening hypotension in 63 (59%), reverse and reduced dipping in 85 (79.4%) and 13 (12.1%). No differences were observed between PD, MSA, and PAF; vasoactive and dopaminergic medications were not associated with significant ABPM differences. Cluster analysis showed two distinct patterns of BP alterations in PD patients: the first (PD1) was characterized by normal BP loads, low prevalence of SH, and milder ABPM alterations; the second (PD2) by increased nighttime BP, high BP loads, higher prevalence of SH, reverse dipping, awakening hypotension and increased BPV. Prevalence of symptomatic OH and severity of CAN were similar between the two clusters. PD2 were older (p<0.05) and treated with lower doses of dopamine agonists (p<0.05).

Conclusion: Regardless of the neurological diagnosis and pharmacological treatment, patients with alpha-synucleinopathies showed a BP circadian rhythm characterized by increased BPV, reverse dipping, increased BP load, and awakening hypotension. Two distinct clusters of circadian BP alterations were detected in PD.

References: Milazzo V, Di Stefano C, Vallelonga F, Sobrero G, Zibetti M, Romagnolo A, Merola A, Milan A, Espay AJ, Lopiano L, Veglio F, Maule S. Reverse blood pressure dipping as marker of dysautonomia in Parkinson disease. Parkinsonism Relat Disord 2018;56:82-87

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MDS Abstracts - https://www.mdsabstracts.org/abstract/alterations-of-blood-pressure-circadian-rhythm-in-alpha-synucleinopathies/