Orthostatic hypotension in Parkinson disease: A 7-year prospective population-based study

Neurology. 2019 Oct 15;93(16):e1526-e1534. doi: 10.1212/WNL.0000000000008314. Epub 2019 Sep 16.


Objective: To determine the frequency, evolution, and associated features of orthostatic hypotension (OH) over 7 years of prospective follow-up in a population-based, initially drug-naive Parkinson disease (PD) cohort.

Methods: We performed repeated lying and standing blood pressure measurements in 185 patients with newly diagnosed PD and 172 matched normal controls to determine the occurrence of (1) OH using consensus-based criteria and (2) clinically significant OH (mean arterial pressure in standing position ≤75 mm Hg). We applied generalized estimating equations models for correlated data to investigate associated features of these 2 outcomes in patients with PD.

Results: OH was more common in patients with PD than controls at all visits, with the relative risk increasing from 3.0 (95% confidence interval [CI] 1.6-5.8; p < 0.001) at baseline to 4.9 (95% CI 2.4-10.1; p < 0.001) after 7 years. Despite a high cumulative prevalence of OH (65.4%) and clinically significant OH (29.2%), use of antihypotensive drugs was very rare (0.5%). OH was independently associated with older age (odds ratio [OR] 1.06 per year; 95% CI 1.03-1.10), lower Mini-Mental State Examination score (OR 0.91 [0.85-0.97] per unit), and longer follow-up time (OR 1.12 [1.03-1.23] per year). Clinically significant OH was associated with the same characteristics, in addition to higher levodopa equivalent dosage (OR 1.16 [1.07-1.25] per 100 mg).

Conclusions: In this population-based study, we found OH to be a very frequent but undertreated complication in early PD, with associations to both disease-specific symptoms and drug treatment. Our findings suggest that clinicians should more actively assess and manage OH abnormalities in PD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Blood Pressure / drug effects
  • Blood Pressure / physiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypotension, Orthostatic / diagnosis
  • Hypotension, Orthostatic / drug therapy
  • Hypotension, Orthostatic / physiopathology*
  • Levodopa / therapeutic use
  • Male
  • Middle Aged
  • Odds Ratio
  • Parkinson Disease / complications
  • Parkinson Disease / drug therapy
  • Parkinson Disease / physiopathology*
  • Prospective Studies
  • Severity of Illness Index


  • Levodopa