Highlights
- •We investigated orthostatic hypotension (OH) symptom in multiple system atrophy (MSA).
- •Mean blood pressure (BP) at 60° tilt < 80 mmHg is related to orthostatic symptoms.
- •Standing mean BP < 80 mmHg is associated with cognitive impairment in MSA with OH.
- •White matter lesions did not correlate with either BP or BP decrease at 60° tilt.
Abstract
The degree and frequency of orthostatic hypotension (OH) are high in patients with
multiple system atrophy (MSA); however, the association of orthostatic blood pressure
(BP) with the symptoms of OH and cognitive impairment in these patients remains unclear.
The aim of this study was to clarify whether absolute BP and/or changes in BP during
standing are related to OH symptoms and cognitive impairment in patients with MSA.
Thirty-two patients with MSA were examined using the head-up tilt and cognitive function
tests. OH symptoms were evaluated using a patient-reported scale. The results were
compared with those for 15 age- and sex-matched healthy controls. Seventeen of the
32 (53.1%) patients had OH, with eight of them exhibiting OH symptoms, which were
related to the absolute BP value at 60° tilt. However, OH symptoms were not related
to the degree of decrease in BP during the tilt test, and they were frequently observed
in patients with a mean BP of <80 mmHg at 60° tilt (sensitivity, 67%; specificity,
91%). Cognitive dysfunction assessed by the Mini-Mental State Examination (MMSE; ≤ 26)
was also associated with a low mean BP at 60° tilt (odds ratio, 1.32; 95% confidence
interval, 1.04–1.67; p = 0.02). The upright BP value is associated with OH symptoms
and the MMSE score in patients with MSA. Thus, careful observation of OH symptoms
can enable early management of BP and the detection of cognitive impairment in these
patients.
Keywords
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Article info
Publication history
Published online: March 28, 2020
Accepted:
March 20,
2020
Received:
January 14,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
