Association of Orthostatic Hypotension with Patient-Reported Outcomes and Dopaminergic Medication in Parkinson Disease: A Pragmatic Cross-Sectional Study.

BACKGROUND

Orthostatic hypotension (OH) is common in Parkinson disease and contributes to injury, fatigue and reduced quality of life. More efficient approaches to identify higher-risk patients are needed.

METHODS

A cross-sectional, single-center study of consecutive people with Parkinson disease was conducted over three months. Linear models adjusted for age, sex and disease duration assessed associations of OH to patient-reported outcomes (autonomic symptoms, quality of life), medications and other clinical features. Receiver operating characteristic curves evaluated patient-reported outcomes as predictors of clinic-measured orthostatic hypotension.

RESULTS

Fifty-seven participants (mean age 69; 60% male) completed assessments. OH was present in 29 (50.9%), but only 3 were symptomatic. The Orthostatic Hypotension Questionnaire showed strong discrimination for OH (sensitivity 81%; specificity 73%). Supine-to-3-minute standing systolic blood pressure dropped most when measured within 1 hour of dopaminergic medication (-17.4 mmHg; 95% CI -30.4 to -4.4) or 1-2 hours (-17.2 mm Hg;-26.8 to -7.6) compared with 2-3 hours (+1.6 mm Hg; -10.0 to + 13.2) or more (-2.9 mmHg; -14.9 to + 9.1). Older age was associated with a greater diastolic blood pressure drop. Delayed OH was associated with worse patient-reported mobility.

CONCLUSION

Orthostatic hypotension was common and usually asymptomatic in this sample. Patient-reported outcomes showed good sensitivity for identifying those likely to have OH. Time since dopaminergic medication impacted the blood pressure drop, and the delayed onset of hypotension was associated with worse mobility-related quality of life. Brief questionnaires may help risk-stratify patients for assessment, counseling and treatment of orthostatic hypotension.