Orthostatic hypotension and non-motor symptoms: results from the PRIME-UK study

Background: Orthostatic hypotension (OH) is common in patients with Parkinsonism and is associated with adverse outcomes including falls. Few studies have investigated phenotypes in which we can predict OH occurring.

Methods: We undertook a retrospective analysis of electronic record data from patients taking part in the PRIME-UK cross-sectional study from a single movement disorder clinic. This included the SCOPAAUT questionnaire. Associations between measures of postural drop and self-reported features of dysautonomia were evaluated using linear regression.

Results: Data was collected from 127 patients and readings, who had undergone postural blood pressure assessment within a year of completing the SCOPA-AUT questionnaire as part of PRIME-UK. Extent of systolic postural blood pressure (BP) drop at 1 min correlated mildly with overall SCOPA-AUT score (- 0.49; CI 0.037, -0.94; p\ 0.034). A strongly significant correlation was seen with the SCOPA AUT gastrointestinal domain for systolic (- 2.1; CI - 1.1, - 3.2; P = 0.0001) and diastolic (- 0.96; CI - 0.33, - 1.6, P = 0.003) BP drop at 1 min, and more weakly for systolic BP change at 3 min (- 1.6, CI - 0.28, - 2.9; P = 0.018). A weak correlation between increasing postural systolic BP at 3 min and the thermoregulatory domain for SCOPA-AUT was seen (2.4; CI 0.17, 4.6, P = 0.035). No significant correlation was seen with cardiovascular SCOPA-AUT domains.

Conclusion: Gastrointestinal symptoms appear to be associated with postural drop, and not cardiovascular symptoms. This may suggest OH may be asymptomatic and that gastrointestinal symptoms could be linked to abnormalities of visceral blood flow. A possible phenotype with thermoregulatory symptoms and increasing postural BP is suggested.