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Are current recommendations to diagnose orthostatic hypotension in Parkinson's disease satisfactory?
Movement Disorders, 07/01/09

Jamnadas-Khoda J et al. – Orthostatic symptoms in Parkinson's disease (PD) have a high specificity but low sensitivity in predicting orthostatic hypotension (OH). In PD, OH occurs often after tilting vs standing and is delayed (after 3 min). As OH in PD is often asymptomatic and delayed, it may contribute to falls and increase morbidity.

• Findings suggest routine evaluation of OH in PD by tilting pts longer than the recommended 3 min to detect delayed OH
• Interview of 50 PD pts by questionnaire to verify reliability of orthostatic symptoms for warning of OH presence
• OH defined as 20 or 10 mm Hg diastolic BP fall within 3 min of tilting or standing
• Late OH (L-OH) defined as fall after 3 min
• Comparison of whether OH in PD was more frequent after head-up tilt or on standing and if the period of postural challenge matters in detecting OH

• For 21 (42%) pts, OH twice more often after tilting (20 pts) vs on standing (10 pts)
• OH within 3 min of tilting in 9 pts (18%); L-OH in 11 pts (55%)
• Of 20 pts, 10 with OH on tilting were symptomatic
• 10 pts with OH on standing were asymptomatic
• Reporting of symptoms independent of age or severity of BP fall
• Most (90%) pts reporting orthostatic symptoms on standing had OH on tilting for 3 min

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