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Titolo:
Orthostatic hypotension in patients with Parkinson's disease - Pathophysiology and management
Autore:
Senard, JM; Brefel-Courbon, C; Rascol, O; Montastruc, JL;
Indirizzi:
Univ Toulouse 3, INSERM, Fac Med Toulouse, Lab Pharmacol Med & Clin,U317, F-31073 Toulouse, France Univ Toulouse 3 Toulouse France F-31073 n,U317, F-31073 Toulouse, France
Titolo Testata:
DRUGS & AGING
fascicolo: 7, volume: 18, anno: 2001,
pagine: 495 - 505
SICI:
1170-229X(2001)18:7<495:OHIPWP>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
MULTIPLE-SYSTEM ATROPHY; POSTPRANDIAL HYPOTENSION; POSTURAL HYPOTENSION; BLOOD-PRESSURE; DOUBLE-BLIND; AUTONOMIC FAILURE; ELDERLY WOMEN; PLACEBO; ERYTHROPOIETIN; OCTREOTIDE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
62
Recensione:
Indirizzi per estratti:
Indirizzo: Senard, JM Univ Toulouse 3, INSERM, Fac Med Toulouse, Lab Pharmacol Med & Clin,U317, 37 Allees Jules Guesde, F-31073 Toulouse, France Univ Toulouse 337 Allees Jules Guesde Toulouse France F-31073
Citazione:
J.M. Senard et al., "Orthostatic hypotension in patients with Parkinson's disease - Pathophysiology and management", DRUG AGING, 18(7), 2001, pp. 495-505

Abstract

Orthostatic hypotension is common in elderly patients, and is now considered to be an important prognostic factor for cognitive decline and mortality. In patients with Parkinson's disease, the prevalence of symptomatic orthostatic hypotension may be as high as 20%. Two factors could explain this high prevalence. First, dopaminergic drugs may induce or worsen orthostatic hypotension. Secondly, Parkinson's disease is a cause of primary autonomic failure with an involvement of the peripheral autonomic system as shown by the ubiquitous distribution of Lewy bodies and reduced iobenguane [metaiodobenzylguanidine (MIBG)I cardiac uptake. These pathological and pharmacological characteristics clearly differentiate autonomic failure of Parkinson's disease from multiple system atrophy. If autonomic abnormalities appear to be present from the first stage of the disease, early onset (within the first year) of symptomatic orthostatic hypotension in the course of parkinsonism can be considered as an exclusion criteria for idiopathic Parkinson's disease. No specific clinical trials have evaluated the effects of antihypotensive drugs in patients with Parkinson's disease and thus no specific therapeuticstrategy can be recommended. The management of orthostatic hypotension in patients with Parkinson's disease should always start with patient education and nonpharmacological treatment. Drug therapy should be reserved for symptomatic patients who do not get benefit from nonpharmacological management. Among the available drugs, alpha (1)-adrenergic agonists (mainly midodrine) or plasma volume expanders (mainly fludrocortisone) are the most frequently used. There are also some drugs that are currently investigational suchas yohimbine and droxidopa. Other drugs such as desmopressin or octreotidemay be of interest in some situations. Domperidone is widely used in patients with parkinsonism with no proven effect on orthostatic hypotension.

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Documento generato il 04/04/20 alle ore 15:02:47