Revealing Non-Motor Symptom Profiles of Orthostatic Hypotension Subtypes in Parkinson's Disease: Insights From a Multidimensional Case-Control Study.

Orthostatic hypotension (OH) represents a cardinal non-motor manifestation in Parkinson's disease (PD), yet the clinical relevance of its subtypes remains unclear. This study aimed to characterize the clinical and blood pressure (BP) profiles of PD-OH and its subtypes. We enrolled 186 PD patients, including 59 with OH, and collected clinical, postural BP, autonomic, cognitive, emotional, sleep, and REM sleep behavior disorder (RBD) data. Analyses used t-tests, nonparametric tests, and chi-square tests as appropriate. Compared to PD-nOH, PD-OH patients had later onset, higher RBD prevalence, poorer visuospatial function, and better subjective sleep quality. They exhibited lower systolic/diastolic BP (SBP/DBP) and larger orthostatic drops across postures. Within PD-OH, diastolic OH with greater cognitive impairment and specific sleep alterations, while symptomatic with worse motor and autonomic function. RBD was linked to greater autonomic dysfunction; depressive symptoms specifically distinguished PD-OH-RBD, whereas cognitive differences distinguished PD-RBD. Advanced PD-OH showed lower SBP/DBP, especially when seated and immediately after standing. In conclusion, D-OH and symptomatic OH are associated with more severe non-motor symptoms, with cognitive and depressive profiles helping distinguish the interaction of PD, OH, and RBD.