Objective: To depict 24 hour blood pressure profile, especially dipping patterns, in subjects with probable and clinically established multiple system atrophy (MSA).

Background: Impairment of parasympathetic and sympathetic function i.e. orthostatic hypotension is one of the core autonomic features of MSA, [1] not only orthostatic hypotension, other studies report autonomic disturbances in MSA patients also seen in circadian blood pressure with changes in nocturnal dipping pattern, although there are still few studies. [2] Ambulatory blood pressure monitoring (ABPM) is a tool that can be applied and can provide vital information to assess blood pressure patterns for 24 hours in MSA patients.

Method: MSA patients based on The Movement Disorder Society Criteria for the Diagnosis of Multiple System Atrophy 2022 in 2022, were included in the study. The blood pressure data were collected for 24 hours using ABPM. The blood pressure values obtained are then processed to obtain systolic and diastolic averages, dipping values and patterns, and nocturnal hypertension events.

Results: There were 5 subjects, with 3 clinically established (2 MSA-C and 1 MSA-P) and 2 clinically probable MSA. The median age was 49 (43-70) years old, with the onset of disease in the established group was 4 (3-6) years and in the probable group was 10 and 14 years. None of the subjects had any vascular comorbidities, including hypertension. The average systolic and diastolic BP was found to be slightly lower in the clinically established group at 24 hours, daytime, and nighttime. Abnormalities of circadian BP rhythm were observed in 66.7% of clinically established subjects and 50% of subjects with probable MSA, with non-dipping patterns. All MSA-C subjects had non-dipping patterns. Nocturnal hypertension was found in 60% of all subjects. [Table 1]

Conclusion: Abnormalities of circadian BP rhythm, specifically non-dipping patterns and nocturnal hypertension, were evident in MSA subjects.

References: 1. Wenning GK, Stankovic I, Vignatelli L, et al. The Movement Disorder Society Criteria for the Diagnosis of Multiple System Atrophy. Mov Disord. 2022;37(6):1131-1148.
2. Pilleri M, Levedianos G, Weis L, et al. Heart rate circadian profile in the differential diagnosis between Parkinson disease and multiple system atrophy. Parkinsonism Relat Disord. 2014;20(2):217-221.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/blood-pressure-monitoring-in-multiple-system-atrophy-focused-on-nocturnal-dipping-pattern/