Clinical Study Of Ambulatory Blood Pressure Changes In Patients With Early Parkinson's Disease

Objective:To estimate the status of cardiovascular autonomic nerve function in patients with early Parkinson's disease(PD)by studying the changes of 24-hour ambulatory blood pressure,recumbent blood pressure and postprandial blood pressure,and further study the relationship of among cardiovascular autonomic dysfunction and age,Gender,course,clinical subtype,levodopa equivalent dose,Hoehn-Yahr(H-Y)staging,Parkinson's disease unified assessment scale part three(UPDRS?)score,history of hypertension.Methods:Collect 40 cases of PD patients(PD group)and 33 cases of healthy control group(control group).All the subjects who met the standard were tested on 24h ambulatory blood pressure monitor for 24hour ambulatory blood pressure monitoring.Participants recorded the time of breakfast,sleeping,daytime activities and nighttime sleep,comparative analysis the characteristics of circadian blood pressure rhythm,blood pressure variability,and postprandial blood pressure changes in the two groups.medical workers performed PD recumbent blood pressure monitoring for PD patients as OH screening,improved the H-Y stage and UPDRS III score,selected early PD patients with H-Y stage of 1-2.5 as the test group,and performed levodopa equivalent daily dose(LEDD)Conversion,to further study the related factors affecting PD early cardiovascular autonomic nerve damageResults:1.The average night-time blood pressure level in the PD group was higher than that in the control group.The circadian blood pressure rhythm was dominated by non-spoon-type blood pressure and anti-spoon-type blood pressure,while the control group tended to scoop-type blood pressure(P<0.01).2.Compared with the healthy control group,the PD group blood pressure variability(BPV)index 24h systolic pressure standard deviation(24hDBPSD),day systolic pressure standard deviation(dDBPSD),night systolic pressure standard deviation(nDBPSD)index is high,indicating that The circadian blood pressure fluctuates greatly,and the variation of systolic blood pressure is dominant.BPV indicators were positively correlated with age,rigid subtype,and associated hypertension(P<0.05),and were not related to gender,disease course,H-Y stage,UPDRSIII score,and levodopa equivalent daily dose(P>0.05).3.The PD blood pressure value in the supine position of the PD group did not meet the diagnostic criteria for orthostatic hypotension;the PD group had not postprandial hypotension,but the level of systolic blood pressure drop 1h after breakfast was higher than that of the control group(P<0.01),and the blood pressure decreased after breakfast Level were positively correlated with course of disease.Conclusion:There is pathological blood pressure rhythm and blood pressure variability in early PD patients,which is manifested by the increasing of the average night blood pressure or decreasing of the magnitude of the decline and the increasing of BPV index,which is a potential sign of cardiovascular autonomic dysfunction.Age,akinetic-rigid type and history of hypertension are the influencing factors of cardiovascular autonomic dysfunction in PD patients.In patients with early PD,there may be not orthostatic hypotension and postprandial hypotension,but the postprandial blood pressure drop level is higher than that of normal people.It may be related to the early impairment of autonomic nerve function in the disease.The longer the course of disease,the higher the incidence of hypotension.