Objective: To evaluate the feasibility and value of home lying-standing blood pressure monitoring in the detection of orthostatic hypotension (OH) in people with parkinsonism (PwP).

Background: Between 30%-50% of PwP have OH and this is asymptomatic in around a third. Independent of symptoms, people with OH have greater functional impairment and likelihood of falls. Screening for OH typically takes place at an annual clinic review using a lying and standing blood pressure (LSBP) reading. However BP is known to be variable and this single measurement may miss OH, or a detect an isolated episode. In line with the use of home BP monitoring in hypertension, home LSBP monitoring could support better detection and management of OH in PwP.

Method: PwP enrolled in the PRIME-UK trial were eligible. An index clinic LSBP measurement was recorded, education was given on home LSBP measurement and a BP monitor, diary and stopwatch were loaned. Participants recorded and documented three home LSBP readings a day over seven days. Descriptive analysis was conducted on diary data including percentage completion, number of readings meeting OH criteria and comparison of clinic and home readings.

Results: 180 participants were consented of 214 eligible. 152/180 (84%) returned diaries. Paired clinic and diary data was available for 117/180 participants (66%). Of these, 44 (38%) had clinic detected OH (symptomatic n=7 (6%), asymptomatic n=37 (32%)). Diary data showed 110/117 (94%) had at least one home OH episode, with a median number of 4 home OH episodes (IQR 1-10). These were relatively evenly distributed across the three timepoints during a day. All but one of those with clinic OH had ≥1 episode of home recorded OH, which were symptomatic in 42% and asymptomatic in 58%.  Notably, in those without OH in clinic, we established that 69/73 (95%) had ≥1 home OH episode and the majority (n=61(84%)) were asymptomatic.

Conclusion: Home LSBP readings are feasible in PwP. Home LSBP monitoring detects more cases of OH than a single clinic reading. Almost all participants had ≥1 home OH episode over 7 days and the majority were asymptomatic. Further research needs to establish the value of increased detection, which patterns of OH are associated with poorer outcomes and what clinical approach should be taken to manage asymptomatic OH in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/how-feasible-and-valuable-is-home-lying-standing-blood-pressure-monitoring-in-people-with-parkinsonism/