Circadian Rhythms In Blood Pressure And Heart Rate In Parkinson’s Disease,Multiple System Atrophy And Progressive Supranuclear Palsy

ObjectiveParkinson’s disease(PD),multiple system atrophy(MSA)and progressive supranuclear palsy(PSP)are common neurodegenerative diseases affecting the basal ganglia.The clinical features of the three groups of diseases overlap broadly,making it difficult to diagnosis,early identification of neurodevelopmental impairment remains challenging.Autonomic dysfunction has been reported in patients with Parkinson’s disease and Parkinsonian syndromes,especially cardiovascular autonomic dysfunction can occur early in the disease.Physiological measures,including heart rate or blood pressure,can provide important information,especially the 24-h semiautomatic ambulatory blood pressure monitoring(24h ABPM)can fully reflect the 24-h blood pressure changes and circadian rhythms of subjects.The purpose of this study was to evaluate circadian rhythm changes in blood pressure and heart rate in patients with PD,MSA and PSP and the comparison of 24-hour blood pressure and heart rate variability between three groups.To improve our understanding of the three groups of diseases,and provide more references for early clinical diagnosis and correct treatment.MethodsThe clinical data of the 24-hour ambulatory blood pressure monitoring and ambulatory electrocardiogram was executed in all patients,including 110 cases of PD,111 cases of MSA and 39 cases of PSP,in department of neurology of our hospital from June 2015 to October 2020.ABPM and HOLTER parameters included 24-hour systolic blood pressure(24hSBP),24-hour diastolic blood pressure(24hDBP),daytime systolic blood pressure(dSBP),daytime diastolic blood pressure(dDBP),nighttime systolic blood pressure(nSBP),nighttime diastolic blood pressure(nDBP),mean arterial pressure(MAP),blood pressure load(BP load),blood pressure variability(BPV),time-domain heart rate variability and frequency-domain heart rate variability.According to the clinical diagnosis,the blood pressure and heart rate monitoring results were compared between groups.To evaluate the circadian rhythms of 24-hour blood pressure and heart rate among patients with PD group,MSA group and PSP group.Results1 A total of 260 patients were included in the study,including 110 patients with PD,111 with MSA and 39 with PSP,of these,there were 144 were males(55.4%)and 116 females(44.6%).The mean age of PD,MSA and PSP patients was 64.2 years,60.5 years and 66.8 years,respectively.The age of PSP group was slightly higher than that of MSA group and PD group(P<0.05).2 The course of disease in PD,MSA and PSP groups was 4.8±4.7/2.3±2.1/3.0±2.9 years.Compared with PD group,MSA group and PSP group had shorter course of disease(P<0.05).However,there was no significant difference in disease course between MSA group and PSP group(P>0.05).3 The H-Y stages in PD group,MSA group and PSP group were 2.8±1.0/3.5±0.6/3.6±0.6.Compared with PD group,MSA group and PSP group have higher H-Y stages of disease and more serious(P<0.05).However,there was no difference in disease severity between PSP group and MSA group(P>0.05).4 There were 33 dipper-type patients(13%),99 weak-dipper patients(38%)and 128 reverse-dipper patients(49%)in three groups.Blood pressure variability(BPV)showed that 85%PD,89%MSA and 87%PSP had abnormal circadian rhythms of blood pressure,indicating that the nocturnal blood pressure in the three groups did not normal descent(<10%),or even increased.5 24-h ABPM showed that the blood pressure and blood pressure load of PSP group and MSA group were significantly higher than those of PD patients.Especially PSP group was significantly higher than PD group(P<0.05)in dSBP,nSBP,24hSBP,nDBP,24hDBP,nMAP,24hMAP,dSBP load,nSBP load and 24hSBP load.MSA group was significantly higher than PD group(P<0.05)in nDBP,nMAP,nSBP load,nDBP load,24hSBP load and 24hDBP load.6 Heart rate variability(HRV)showed that 34%PD,39%MSA and 41%PSP was below the normal range in three groups.There was no significant difference in the frequency-domain and time-domain of heart rate variability among PD,MSA and PSP groups(P>0.05).7 The LF/HF ratio in PD group,MSA group and PSP group was 1.4(1.0,2.2)/1.3(0.7,2.6)/1.7(1.0,2.6).There was no difference in LF/HF ratio among the three groups(P>0.05).Conclusions1 The circadian rhythm of blood pressure was abnormal in PD,MSA and PSP groups.The 24-hour mean blood pressure and blood pressure load in PSP group and MSA group were significantly higher than those in PD patients.2 The circadian rhythm of heart rate in PD,MSA and PSP groups was below the normal range,however,there was no significant difference in heart rate variability among the three groups.