A Clinical Study Of Ambulatory Blood Pressure In 180 Patients With Parkinson's Disease

Background and objectiveParkinson's disease is a common neurodegenerative disorder,and it has motor symptoms and non-motor symptoms which include sensory disorder,neuropsychiatric disorder,sleep disorder,cognitive disorder and autonomic disorder.Cardiovascular dysfunctions are typical features of impaired autonomic nervous system in Parkinson's disease.In the terms of blood pressure,it includes orthostatic hypotension,supine hypertension,nocturnal hypertension and lost blood pressure circadian rhythm.They are connected with each other.Dysfunctions of cardiovascular system may lead to cerebral insufficiency,dizziness,falling,fainting or transient loss of consciousness and so on.What's more,cardiovascular symptoms are closely related to decreased motor function,decreased quality of life,decreased survival rate and increased mortality in patients with Parkinson's disease.Therefore,early detection and diagnosis of cardiovascular system function in patients with Parkinson's disease are very important.At present,there are various problems in clinical methods for measuring the severity of cardiovascular system damages in patients with Parkinson's disease.As a tool widely used to evaluate the function of autonomic nervous system,ambulatory blood pressure monitoring can be used as an auxiliary diagnostic tool for autonomic nervous function in Parkinson's disease.This is a case-control study,and it aims to assess blood pressure damages and explore different stages,types and whether to merge the cardiovascular system of ambulatory blood pressure differences in patients with Parkinson's disease through the ambulatory blood pressure monitors,and looks for the possible influenced factors of Parkinson's disease's damaged blood pressure.MethodsCollected 180 cases with idiopathic Parkinson's disease,and 180 gender and age matched healthy cases as controls during August 2015 to August 2018 in the first affiliated hospital of Zhengzhou University neurology department.Adopting noninvasive portable ambulatory blood pressure monitor to detect patients' 24-hour ambulatory blood pressure,evaluating the changes of blood pressure rhythm.Meanwhile,the differences of dynamic blood pressure and related factors in different types and stages of Parkinson's disease were explored.Results1.Compared with the control group,the daytime systolic blood pressure variability,daytime mean heart rate,and nocturnal mean systolic blood pressure,nocturnal mean diastolic blood pressure,nocturnal mean heart rate,nocturnal diastolic blood pressure load,nocturnal systolic blood pressure variability,nocturnal diastolic blood pressure variability,24-hour mean systolic blood pressure,24-hour systolic blood pressure load,24-hour diastolic blood pressure load,24-hour mean heart rate,24-hour systolic blood pressure variability,and area under 24-hour systolic blood pressure curve,area under 24-hour diastolic blood pressure curve and the incidence of abnormal blood pressure circadian rhythm were significantly increased,while mean decrease rate of nocturnal systolic blood pressure,diastolic blood pressure,and mean blood pressure were significantly decreased in the PD group;2.Compared with the tremor subtype of the Parkinson's disease patients,the nocturnal mean systolic blood pressure,nocturnal mean blood pressure and the incidence of abnormal blood pressure circadian rhythm were significantly higher,but mean decrease rate of nocturnal systolic blood pressure and mean decrease rate of nocturnal mean blood pressure were significantly decreased during the Parkinson's disease patients with postural instability and gait disorder;3.Compared with the Parkinson's disease patients in the early stage,the daytime systolic blood pressure variability,nocturnal mean systolic blood pressure,nocturnal mean diastolic blood pressure,nocturnal mean blood pressure,nocturnal mean heart rate,nocturnal systolic blood pressure load,and 24-hour mean systolic blood pressure,24-hour mean diastolic blood pressure,24-hour mean heart rate,24-hour systolic blood pressure load,and the incidence of abnormal blood pressure circadian rhythm were significantly increased,and mean decrease rate of nocturnal systolic blood pressure,mean decrease rate of nocturnal diastolic blood pressure and mean decrease rate of nocturnal mean blood pressure were significantly decreased during the patients in the middle-late stage;4.Compared with the Parkinson's disease patients without cardiovascular symptoms,the daytime systolic blood pressure load,daytime systolic blood pressure variability,nocturnal systolic blood pressure variability,24-hour systolic blood pressure variability and the incidence of abnormal blood pressure circadian rhythm were significantly increased,while mean decrease rate of nocturnal diastolic blood pressure was decreased obviously in the patients with cardiovascular symptoms;5.There was a negative correlation between mean decrease rate of nocturnal mean blood pressure with the durations,H-Y grades,UPDRS-? scores,and the cardiovascular symptoms.Besides,the nocturnal systolic blood pressure variability was positively correlated with the durations,H-Y grades,UPDRS-? scores,and the cardiovascular symptoms;Conclusion1.Mean decrease rate of nocturnal mean blood pressure,the nocturnal systolic blood pressure variability and blood pressure circadian rhythm disorders are effective indicators of impaired autonomic nervous system in Parkinson's disease.2.Patients with postural instability and gait disorders,cardiovascular symptoms or in the middle-late stages have more severe blood pressure circadian rhythm disorders.