Abstract Details

Title Impact of Supine Hypertension in Target Organ Damage and Mortality in Patients with Neurodegenerative Synucleinopathies

Topic Movement Disorders

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-004

Objective We hypothesized that supine hypertension in patients with neurogenic orthostatic hypotension (nOH) caused by neurodegenerative synucleinopathies increases the risk of target organ damage and negatively impacts survival.

Background In addition to nOH, patients with Parkinson disease and other synucleinopathies frequently have supine hypertension. The consequences of both problems are difficult to disentangle.

Design/Methods Patients with autonomic synucleinopathies underwent standardized autonomic function tests, full neurological examination, and ambulatory 24-hour blood pressure monitoring (ABPM). We assessed target organ damage by measuring cerebral white matter hyperintensities (WMH), left ventricular hypertrophy (LVH), and renal function. We prospectively followed these patients for 27 months (range:12-56 months) and recorded incident cardiovascular events and all-cause mortality.

Results Fifty-seven patients (35 with multiple system atrophy, 14 with Parkinson disease and 8 with pure autonomic failure) with nOH completed autonomic, cardiovascular, renal, and brain magnetic resonance imaging evaluations, and had ABPM. Thirty-eight patients (67%) had supine hypertension (systolic BP>140 mmHg). There patients had higher blood urea nitrogen levels (P=0.005), lower estimated glomerular filtration rate (P=0.008), higher prevalence of LVH (P=0.040), and higher WMH volume (P=0.019) compared to those without hypertension. Within 27.1±14.5 months of follow-up, 25 subjects (6 without, 19 with supine hypertension) had died (22 patients), had nonfatal myocardial infarction (1 patient), or had nonfatal stroke (2 patients). Time to cardiovascular event/death was shorter in patients with supine hypertension compared to patients without supine hypertension (36 vs.50 months; HR=3.28, P=0.010).

Conclusions

Supine hypertension in patients with autonomic failure caused by neurodegenerative synucleinopathies is associated with an increased risk for target organ damage, cardiovascular adverse events, and premature death. Our findings have therapeutic implications.

Authors/Disclosures
Jose-Alberto Palma, MD, PhD, FAAN (New York University Grossman School of Medicine) PRESENTER	Dr. Palma has received personal compensation for serving as an employee of Eli Lilly. The institution of Dr. Palma has received research support from National Institutes of Health. Dr. Palma has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Horacio C. Kaufmann, MD, FAAN (NYU Langone Health - NYU Dysautonomia Center)	Dr. Kaufmann has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Theravance. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva Pharmaceuticals. Dr. Kaufmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Curasen Therapeutics. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AskBio. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BioArctic. Dr. Kaufmann has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Spinger. The institution of Dr. Kaufmann has received research support from Biogen. The institution of Dr. Kaufmann has received research support from Vaxxinity. Dr. Kaufmann has received publishing royalties from a publication relating to health care.

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