Objective: To investigate the effect of BP parameters on survival in MSA patients by MSA type and sex.

Background: Multiple system atrophy (MSA) is a rare progressive neurodegenerative disorder. One of its main features is blood pressure fluctuations with orthostatic hypotension (OH) and supine hypertension. OH has been described as an independent predictor of all-cause mortality.

Methods: The cohort included 99 MSA patients (53% males) whose BP measurements were obtained during a 40-minute drug-free tilt test with the patient in a vertical position. For survival analysis we used y Kaplan–Meier curves, and Cox regression to estimate adjusted (to age of onset) hazard ratios (HRs) of BP measurements on time to death. Analysis was stratified by sex and MSA type.

Results: Sixty-three of the 99 MSA patients (64%) had MSA-P and 36 had MSA-C. In the whole cohort, mean age of onset was 61.1±10.4 years, and mean disease duration was 8.0±4.7 years. The MSA-P and MSA-C groups did not differ significantly in age at disease onset, male/female ratio. Survival time did not differ significantly between the MSA-P and MSA-C groups (Medians: 12 years [95%CI: 8-28] and 10 years [95%CI: 8-13], respectively). There was a trend towards better survival for males compared to females in the MSA-P group (log-rank p=.0925). Maximal diastolic BP decline had a borderline positive association with risk of death among MSA-C males (adjusted HR=1.18, p=.0665). Systolic BP measured after 10 minutes (supine position) had a significant positive association with risk of death only in MSA-P males (adjusted HR=1.06, p=.0354).

Conclusions: The findings of a sex difference in the effect of BP on death risk may be important for adjusting the therapeutic approach and may be a further step towards personalized medicine for these severely disabled patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-relationship-between-blood-pressure-sex-and-survival-in-multiple-system-atrophy/