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Abstract Details

The Relationship Between Changes in Orthostatic Blood Pressure and Symptoms in Patients with Orthostatic Hypotension
Neuromuscular and Clinical Neurophysiology (EMG)
P3 - Poster Session 3 (5:30 PM-6:30 PM)
7-046
To define the relationship between changes in BP on orthostatic symptom development in patients with OH.
Orthostatic hypotension (OH) is a common feature of many neurological disorders, including the alpha-synucleinopathies. Patients with OH can present with a wide range of symptoms, although often without clear link to blood pressure (BP).
In this retrospective study we reviewed 1037 charts of patients for autonomic testing from January 2016 to March 2018. Systolic, diastolic and mean arterial pressures were recorded continuously and each minute of testing.  Change in blood pressures was compared to baseline values after supine rest, prior to testing. BP measures included the lowest BP in the first 3 minutes of tilt, the absolute BP value on tilt vs the lowest and the orthostatic BP-drop. Subjects were questioned about symptoms of orthostatic intolerance at baseline and two times during the first ten minutes of tilt.
Eighty-nine patients (57% male, mean age 69 years) with OH were included in the final analysis.  All patients completed the symptom questionnaires during tilt table testing. Supine hypertension was present in 59%. The majority (78/89) of patients had OH related to neurodegenerative disease or peripheral neuropathy, with lightheadedness and dizziness the most common symptoms. There was no relationship between magnitude of blood pressure fall and maximum symptoms (R2=0.0, P=NS) or total symptoms (R2=0.04, P=NS).  There was no relationship between absolute lowest blood pressure and maximum symptoms (R2=0.02, P=NS) or total symptoms (R2=0.05, P=NS).
These results suggest a poor relationship between the magnitude of the orthostatic blood pressure fall, the absolute orthostatic blood pressure and symptoms.  Many patients are asymptomatic despite substantial BP falls and low orthostatic blood pressures.  These findings have implications for clinical care of patients with OH and clinical trials to treat patients with OH.
Authors/Disclosures
Roy L. Freeman, MD (Beth Israel Deaconess Hosp)
PRESENTER 		Dr. Freeman has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Cutaneous Diagnostic Life Sciences. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vertex. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theravance. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Inhibikase. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Freeman has received research support from NIH. The institution of Dr. Freeman has received research support from Theravance. The institution of Dr. Freeman has received research support from Biohaven. The institution of Dr. Freeman has received research support from Lundbeck. Dr. Freeman has received research support from Regeneron.
Christopher H. Gibbons, MD, FAAN (Beth Israel Deaconess Medical Center) Dr. Gibbons has received personal compensation for serving as an employee of CND Life Sciences. Dr. Gibbons has or had stock in CND Life Sciences.Dr. Gibbons has received publishing royalties from a publication relating to health care.
No disclosure on file
Ben M. Illigens, MD (Beth Israel Deaconess Medical Center) Dr. Illigens has received personal compensation for serving as an employee of Target Health. Dr. Illigens has received personal compensation for serving as an employee of BC Platforms. Dr. Illigens has received personal compensation for serving as an employee of NOVA Discovery. Dr. Illigens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for RDP Pharma. Dr. Illigens has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Biomind Labs. Dr. Illigens has a non-compensated relationship as a Director with Partners for Patients that is relevant to AAN interests or activities.
Marta Campagnolo No disclosure on file
Ahmad R. Abuzinadah, MBBS (Ahmad Abuzinadah) No disclosure on file
Dongin Sinn, MD (Stanford Neurology and Neurological Sciences) The institution of Dr. Sinn has received research support from Theravance BioPharma. The institution of Dr. Sinn has received research support from Dysautonomia International.