APPROXIMATELY 1 IN 5 PATIENTS WITH PARKINSON’S DISEASE EXPERIENCES SYMPTOMS OF nOH

The prevalence of neurogenic orthostatic hypotension (nOH) in patients with Parkinson’s disease may vary, with symptoms affecting approximately 18% of the patient population.1 The variance in prevalence is related to the varying levels of orthostatic stress a patient may be experiencing.2,3

PARKINSON’S DISEASE IS A NEURODEGENERATIVE DISORDER THAT CAN DAMAGE A PATIENT’S AUTONOMIC NERVOUS SYSTEM

Parkinson’s disease is characterized by the loss of predominantly dopaminergic neurons and may affect a patient’s autonomic nervous system.4-6 The autonomic nervous system may not be able to release sufficient levels of norepinephrine in response to postural change. Norepinephrine is the major neurotransmitter responsible for blood pressure maintenance and such a deficiency may cause patients to experience symptoms of nOH.3,5-8 If your patients with Parkinson’s disease are experiencing dizziness, lightheadedness, or other symptoms that improve upon sitting, they could have nOH.6,7,9

SCREENING QUESTIONS MAY HELP IDENTIFY nOH SYMPTOMS IN PATIENTS WITH PARKINSON’S DISEASE

Some patients with Parkinson’s disease may dismiss nOH symptoms as being a part of their pre-existing neurodegenerative disorder.3 Screening questions may help determine if your patient's symptoms are a part of his or her Parkinson's disease, or if they are associated with nOH.10-12

A DEFICIENT AUTONOMIC NERVOUS SYSTEM MAY ALSO MEAN SUPINE HYPERTENSION FOR PATIENTS

Up to 70% of patients with nOH will experience associated supine hypertension. This prevalence is likely due to prolonged disease duration as well as decreased cardiovascular autonomic function.2,6,13 Supine hypertension may occur at any point during the day when a patient is in a recumbent position. Certain daily adjustments may help a patient manage his or her supine hypertension.2,6,14

References: 1. Ha AD, Brown CH, York MK, et al. The prevalence of symptomatic orthostatic hypotension in patients with Parkinson’s disease and atypical parkinsonism. Parkinsonism Relat Disord. 2011;17(8):625-628. 2. Stuebner E, Vichayanrat E, Low DA, et al. Twenty-four hour non-invasive ambulatory blood pressure and heart rate monitoring in Parkinson’s disease. Front Neurol. 2013;4:49. 3. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257. 4. Rousseaux MWC, Shulman JM, Jankovic J. Progress toward an integrated understanding of Parkinson’s disease. F1000Res. 2017;6(F1000 Faculty Rev):1121. 5. Isaacson SH, Skettini J. Neurogenic orthostatic hypotension in Parkinson’s disease: evaluation, management, and emerging role of droxidopa. Vasc Health Risk Manag. 2014;10:169-176. 6. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-891. 7. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. 8. Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009;119(1):139-146. 9. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. 10. Kaufmann H, Malamut R, Norcliffe-Kaufmann L, et al. The Orthostatic Hypotension Questionnaire (OHQ): validation of a novel symptom assessment scale. Clin Auton Res. 2012;22(2):79-90. 11. Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008;7(5):451-458. 12. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567-1582. 13. Berganzo K, Diez-Arrola B, Tijero B, et al. Nocturnal hypertension and dysautonomia in patients with Parkinson’s disease: are they related? J Neurol. 2013;260(7):1752-1756. 14. Jordan J, Biaggioni I. Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens. 2002;4(2):139-145.