Presymptomatic hypertension is a major feature in the diagnosis of progressive supranuclear palsy

Objective: To examine the history of hypertension (HT) in patients with parkinsonism (PS) of various causes. Patients: Nine hundred twenty-three patients with PS listed in a citywide movement disorders registry. Hypertension was defined as blood pressure above 150/90 mm Hg on at least 2 occasions or a history of antihypertensive medication use. Results: Overall, 184 patients (20.6%) had a history of HT. Fifty-three (16.6%) of 320 patients with levodopa-responsive parkinsonism (PD) had a history of HT; similar prevalence of presymptomatic HT was seen for PS and dementia (22/165 [13.3%]), including probable diffuse Lewy body disease and multiple system atrophy of the nigrostriatal degenerative type (33/171 [19.3%]). Olivopontocerebellar atrophy (7/40 [18%]), corticobasal ganglionic degeneration (5/15 [33.3%]), drug-induced PS (9/38 [23.1%]), and the predominantly tremulous forms of Parkinson disease (17/43 [39.5%]) showed a higher prevalence of HT. Patients with familial PS (n=36), early-onset PD (n=14), multiple system atrophy of the Shy-Drager type (n=11), and postencephalitic PS (n=6) had no history of HT. In 100 patients with PS of various rare etiologies, a history of HT was seen in less than 5%. The highest prevalence of HT was seen in patients with clinically diagnosed progressive supranuclear palsy (n=42), of whom 34 (81.0%) had a history of HT. Conclusions: A presymptomatic history of HT is a major feature in the clinical history of progressive supranuclear palsy and may be a diagnostic criterion. Its significance is unknown, but adrenergic nuclei of the brainstem are severely affected, and HT may be the first symptom arising from involvement of these nuclei. This could also explain the features of small vessel disease seen on computed tomography or magnetic resonance imaging in 50% of our patients, as in previous reports.