Severity of orthostatic hypotension in the course of Parkinson's disease: No correlation with the duration of the disease

Background: Orthostatic hypotension (OH) is a common issue in Parkinson's disease (PD), affecting about 30%-40% of PD patients. Symptoms of OH include lightheadedness, dizziness, postural instability, vertigo and blurred vision. OH considerably contributes to disease burden and reduced quality of life for PD patients. Objective: To determine whether the severity of OH in PD advances significantly with the duration of the disease. Methods: For 106 PD patients lying-to-standing orthostatic tests were performed to evaluate orthostasis. Severity of OH was measured as maximal drop of systolic blood pressure (SBP) after postural challenge, as the mean of three measurements. The relationship between the maximal drop of SBP and the duration of PD was tested applying ANOVA. Consecutively, 64 patients under regular ambulant supervision received appointments to evaluate their orthostasis repeatedly. From these patients a separate cohort was set up to investigate OH progression in the course of PD. Results: The lack of a correlation between the severity of OH in PD and the duration of the disease was determined (p = 0.064). The long term analysis for the patients under regular ambulant supervision demonstrated that the severity of OH does not advance in the course of PD in a statistically significant manner (p = 0.83). Conclusions: OH does not appear to be a symptom only of the late stage of PD. The presence of OH along with early motor signs does not necessarily point to multiple system atrophy. (C) 2014 Elsevier Ltd. All rights reserved.