Objectives
To determine the prevalence of orthostatic hypotension (OH) in patients with Parkinson’s disease (PD), compare clinical factors between patients with and without OH, examine associations with PD medications, antihypertensives and polypharmacy, and compare outcomes between symptomatic and asymptomatic OH, including falls, emergency department (ED) presentations related to falls and mortality.
Methods
A retrospective review was conducted of 208 patients attending the Movement Disorder Clinic between April and July 2023. Electronic medical records were reviewed for OH diagnosis, symptomatic status, falls, ED presentations and mortality. Continuous variables were analysed using Student’s t-test, and categorical variables using chi-squared tests.
Results
Among 208 patients, 93 (44.7%) had OH, including 19 (9.1%) with symptomatic OH. There were no significant differences between patients with and without OH in age, gender, total levodopa dose, antihypertensive use or degree of polypharmacy. Pharmacological treatment for OH was used in 22.1% of patients. OH was associated with increased risk of falls prior to clinic review, ED presentation secondary to falls within 12 months, and mortality compared with patients without OH. These associations were statistically significant for prior falls (OR 2.01, 95% CI 1.06–3.81, p = 0.03) and ED presentations due to falls (OR 2.2, 95% CI 1.03–4.72, p = 0.04) after adjustment for symptomatic status, age, disease duration, medication burden and antihypertensive use.
Conclusions
OH is common in PD and frequently asymptomatic. Both symptomatic and asymptomatic OH are associated with increased morbidity. Routine screening for OH in PD patients is recommended, with consideration of treatment when detected.