Head-up tilt test identified orthostatic hypotension in 28% of idiopathic Parkinson’s disease patients, with prevalence strongly increasing with disease duration and severity (p < 0.00001).
Observational (n=114)
No
Orthostatic hypotension affects 28% of patients with idiopathic Parkinson's disease and its prevalence strongly correlates with longer disease duration and higher motor severity, highlighting the utility of routine head-up tilt testing for early detection.
Introduction: Parkinson’s disease (PD) is a neurodegenerative disorder, affecting individuals aged 60 and older, with rapidly increasing prevalence in aging populations, particularly in India. Apart from classical motor symptoms, nonmotor symptoms, particularly orthostatic hypotension (OH), significantly affect the quality of life, increasing the fall risk that contributes to increasing morbidity and mortality. This single-center, prospective, cross-sectional observational study evaluates OH, a key cardiovascular autonomic dysfunction, in idiopathic PD patients using the head-up tilt test (HUTT) to assess its prevalence and correlation with disease duration and severity. Conducted from July 2023 to June 2024 at the Department of Neurology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry, India, the study enrolled 114 patients diagnosed according to UK Brain Bank criteria, excluding confounders such as diabetic neuropathy or cardiovascular comorbidities. Methods: Patients underwent detailed clinical evaluation, demographics, PD duration, autonomic symptom history, and Modified Hoehn and Yahr staging, and the HUTT was commenced at 60° after 30 minutes of supine rest. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure, and heart rate were obtained every five minutes before tilt; one, three, and five minutes during tilt; and one minute after tilt, as indicated for patient safety. OH was defined as a drop in SBP ≥20 mmHg and/or DBP ≥10 mmHg within three to five minutes. Data analysis used Statistical Package for the Social Sciences version 20 (IBM Corp., Armonk, NY) with chi-square test, analysis of variance, t tests, and Pearson correlation (p < 0.05 significant). Ethical approval was obtained from the institution’s ethics committee, and informed consent was obtained to ensure confidentiality. Results: The mean age was 65 ± 11.19 years, 62.28% were male, and the mean disease duration was 2.75 ± 1.93 years. OH prevalence was 28% (32/114 patients). No gender association was observed (p = 0.180), but strong links with duration (p < 0.00001; 0% in less than one year, 100% in greater than five years) and H 7.4% stage 1, 100% stage 3) were noticed. Disease duration positively correlated with H HUTT enables proactive management to enhance the quality of life.
Ramanan et al. (Fri,) conducted a observational in Patients aged 40-85 with idiopathic Parkinson’s disease diagnosed by UK Brain Bank criteria, excluding those with diabetic neuropathy, cardiovascular comorbidities, and medications affecting autonomic function other than anti-Parkinsonian drugs (n=114). Head-up tilt test (HUTT) was evaluated on Prevalence of orthostatic hypotension (OH), defined as sustained drop in systolic BP ≥20 mmHg and/or diastolic BP ≥10 mmHg within 3-5 minutes of head-up tilt test (95% CI 19.8-36.2%). Head-up tilt test identified orthostatic hypotension in 28% of idiopathic Parkinson’s disease patients, with prevalence strongly increasing with disease duration and severity (p < 0.00001).