Published Online
on November 13, 2006

A more recent version of this article appeared on January 1, 2007

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Submitted on August 9, 2006
Revised on September 2, 2006

Early Abnormalities of Vascular and Cardiac Autonomic Control in Parkinson’s Disease Without Orthostatic Hypotension

Franca Barbic; Francesca Perego; Margherita Canesi; Michela Gianni; Sara Biagiotti; Giorgio Costantino; Giovanni Pezzoli; Alberto Porta; Alberto Malliani; and Raffaello Furlan^*

From the Medicina Interna II (F.B., F.P., M.G., S.B., G.C., A.P., A.M., R.F.), Ospedale L. Sacco, Università degli Studi di Milano, Milan, Italy; and Centro Parkinson e Disordini del Movimento (M.C., G.P.), Istituti Clinici di Perfezionamento, Milan, Italy.

^* To whom correspondence should be addressed. E-mail: raffaello.furlan{at}unimi.it.

Abstract--Cardiac autonomic abnormalities have been described in Parkinson’s disease. Little is known about possible alterations of vascular sympathetic regulatory activity in patients without orthostatic hypotension or symptoms of orthostatic intolerance. Nineteen patients with Parkinson’s disease without orthostatic hypotension (PD), 21 with orthostatic hypotension (PDOH), and 20 healthy controls underwent ECG, beat-to-beat arterial pressure, and respiration recordings while recumbent and during a 75° head-up tilt. Spectrum analysis of RR interval and systolic arterial pressure (SAP) variability provided indices of cardiac sympathovagal interaction (low frequency [LF]/high frequency [HF]) to the sinoatrial node and sympathetic vasomotor control (LF_SAP). Arterial baroreceptor mechanisms were assessed by the spontaneous sequences technique and bivariate spectrum analysis ( index). Plasma catecholamines provided the neurohormonal profile. At rest, hemodynamics and spectral markers of autonomic function were similar in PD and control subjects. Norepinephrine was lower in PD and PDOH than in control subjects. In PDOH, SAP was higher, whereas LF/HF ratio and LF_SAP were lower compared with control subjects. During tilt, SAP was unchanged in PD; however, similar to PDOH, the increase of heart rate, LF/HF ratio, and LF_SAP was blunted compared with control subjects. Baroreflex indices were unmodified in PD and PDOH compared with control subjects. Initial alterations in both cardiac and vascular sympathetic modulatory activity were found in PD and revealed by a gravitational stimulus. Prompt recognition of sympathetic abnormalities might result in earlier therapeutic intervention, reduced orthostatic intolerance, and increased quality of life.

Key words: nervous system • sympathetic • arterial baroreceptors • power spectrum analysis • tilt test • Parkinson’s disease

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