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24-Hour Ambulatory Blood Pressure Monitoring in SWEDDs Patients With Parkinsonism

  • Seok-Jae Kang (a1), Jin Young Ahn (a2), Joong-Seok Kim (a3), Jin Whan Cho (a4), Ji Young Kim (a5), Yun Young Choi (a5) and Hee-Tae Kim (a1)...

Abstract

Background: Patients diagnosed with Parkinson’s disease (PD) on clinics who subsequently turn out to have normal dopamine transporter images have been referred to as scans without evidence of dopaminergic deficits (SWEDDs) patients. Cardiovascular autonomic dysfunction has frequently been reported in PD. In this study, we determined the similarities and differences in cardiac autonomic dysfunction between SWEDDs and PD patients. This study investigated whether 24-hour ambulatory blood pressure monitoring (24-hour ABPM) can help identify possible cases with SWEDDs. Methods: We enrolled 28 SWEDDs patients, 46 patients with PD, and 30 healthy controls. To evaluate cardiac autonomic function, 24-hour ABPM was performed on all subjects. Cardiac metaiodobenzylguanidine (MIBG) scintigraphy was performed on the SWEDDs and PD subjects. Results: The percentage nocturnal decline in blood pressure differed significantly among SWEDDs patients, PD patients, and controls (p<0.05). In addition to the abnormal nocturnal BP, regulation (nondipping and reverse dipping) was significantly higher in SWEDDs and PD subjects than in the control subjects (p<0.05). There was no significant correlation between the % nocturnal blood pressure reduction and parameters of cardiac MIBG uptake ratio. However, orthostatic hypotension was significant correlated with the nocturnal blood pressure dip (%), nocturnal blood pressure patterns, and the cardiac MIBG uptake ratio (early and late) in combined SWEDDs and PD subjects. Conclusions: Pathologic nocturnal blood pressure regulation and nocturnal hypertension, known characteristics of PD, are also present in SWEDDs. Moreover, cardiac sympathetic denervation should not be attributed to cardiac autonomic dysfunction in SWEDDs patients. As with PD patients, the SWEDDs patients studied here tended to have cardiac autonomic dysfunction.

Surveillance de 24 heures de la tension artérielle ambulatoire chez les patients présentant du parkinsonisme sans évidence de déficit dopaminergique. Contexte : Les patients chez qui un diagnostic de maladie de Parkinson (MP) a été posé basé sur la présentation clinique et chez qui éventuellement l’imagerie montre une activité normale du transporteur de la dopamine sont connus comme étant des patients avec scan sans évidence de déficit dopaminergique (scans without evidence of dopaminergic deficits – SWEDDs patients). Une dystonie neurovégétative cardiovasculaire a souvent été rapportée dans la MP. Dans cette étude, nous identifions les similitudes et les différences de la dystonie neuro-végétative cardiaque entre les patients atteints de SWEDD et les patients atteints de MP. Nous avons examiné si l’enregistrement de la tension artérielle ambulatoire de 24 heures (ETAA 24 h) pouvait aider à identifier les cas possibles de SWEDD. Méthode : Nous avons recruté 28 patients atteints de SWEDD, 46 patients atteints de MP et 30 sujets témoins en bonne santé. Un ETAA 24 h a été effectué chez tous les sujets afin d’évaluer la fonction neurovégétative cardiaque. Une scintigraphie cardiaque à la métaiodobenzylguanidine (MIBG) a été effectuée chez les sujets atteints de SWEDD et de MP. Résultats : Le pourcentage de diminution nocturne de la tension artérielle était significativement différent chez les patients atteints de SWEDD, les patients atteints de MP et les sujets témoins (p<0,05). En plus de la TA nocturne anormale, la régulation (absence de diminution et diminution inversée) de la TA était significativement plus élevée chez les sujets atteints de SWEDD et de MP que chez les sujets témoins (p<0,05). Il n’existait pas de corrélation significative entre le % de réduction de la tension artérielle nocturne et les paramètres du ratio de captation cardiaque de MIBG. Cependant, l’hypotension orthostatique était corrélée significativement à la baisse (%) de la tension artérielle nocturne, au profil de la tension artérielle nocturne et au ratio de captation cardiaque de MIBG (précoce et tardif) chez les patients atteints de SWEED et de MP. Conclusions : La régulation nocturne pathologique de la tension artérielle et l’hypertension nocturne, des caractéristiques bien connues de la MP, sont également présentes chez les patients atteints de SWEDD. De plus, la dénervation sympathique cardiaque ne devrait pas être attribuée à une dystonie neurovégétative cardiaque chez les patients atteints de SWEDD. Comme chez les patients atteints de MP, les patients atteints de SWEDD que nous avons étudiés avaient tendance à présenter une dystonie neurovégétative cardiaque.

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Copyright

Corresponding author

Correspondence to: Hee Tae Kim, Department of Neurology, College of Medicine, Hanyang University, 222 wansimni 2-dong, Seongdong-gu, Seoul, 133-792, Republic of Korea. Email: kimht@hanyang.ac.kr

References

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