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@ARTICLE{Fanciulli:284361,
      author       = {Fanciulli, Alessandra and Leys, Fabian and Höglinger,
                      Günter and Jost, Wolfgang H},
      title        = {{H}ow to treat cardiovascular autonomic failure in
                      {P}arkinson's disease.},
      journal      = {Journal of neural transmission},
      volume       = {133},
      number       = {2},
      issn         = {0375-9245},
      address      = {Wien [u.a.]},
      publisher    = {Springer},
      reportid     = {DZNE-2026-00129},
      pages        = {215 - 228},
      year         = {2026},
      abstract     = {Cardiovascular autonomic failure is a frequent non-motor
                      feature of Parkinson's disease (PD) that affects up to one
                      third of individuals from the premotor to the advanced
                      stages of the disease, with major diagnostic, therapeutic
                      and prognostic implications. It may manifest with
                      orthostatic, post-prandial or exercise-induced hypotension,
                      as well as hypertensive episodes in the supine position
                      during wakefulness or nocturnal sleep. Hypotensive episodes
                      may remain asymptomatic or manifest with symptoms of
                      end-organ hypoperfusion in the upright position, after meals
                      or during exertion that may include lightheadedness, blurred
                      vision, cognitive slowness, shuffling gait, back pain,
                      fatigue or, in severe cases, syncope. Supine and nocturnal
                      hypertension are likewise often asymptomatic, yet may cause
                      nocturnal polyuria, and disrupt sleep through frequent
                      nocturnal toilet visits. Bedside screening for
                      cardiovascular autonomic failure relies on targeted history
                      taking, eventually supported by validated questionnaires,
                      and supine to standing heart rate and blood pressure
                      measurements. A more detailed assessment is obtained with
                      cardiovascular autonomic function tests under continuous,
                      non-invasive, hemodynamic monitoring, complemented by
                      24-hours ambulatory blood pressure monitoring and home blood
                      pressure diaries. Hypotensive episodes are managed by
                      addressing potential triggers, such as infections, anemia,
                      dehydration and polypharmacy, followed by a stepwise
                      implementation of behavioral, non-pharmacological and
                      pharmacological strategies. Individuals with orthostatic
                      hypotension should be constantly monitored for concomitant
                      supine and nocturnal hypertension, especially if treatment
                      with pressor agents has been recently started. Hypertensive
                      episodes are likewise treated in a stepwise fashion with
                      preventive, non-pharmacological and pharmacological
                      measures, prioritizing hypotension control during daytime
                      and mitigating hypertension overnight.},
      subtyp        = {Review Article},
      keywords     = {Humans / Parkinson Disease: complications / Autonomic
                      Nervous System Diseases: etiology / Autonomic Nervous System
                      Diseases: therapy / Autonomic Nervous System Diseases:
                      diagnosis / Cardiovascular Diseases: therapy /
                      Cardiovascular Diseases: etiology / Cardiovascular Diseases:
                      diagnosis / Nocturnal hypertension (Other) / Orthostatic
                      hypotension (Other) / Parkinson’s disease (Other) /
                      Post-prandial hypotension (Other) / Supine hypertension
                      (Other)},
      cin          = {Clinical Research (Munich)},
      ddc          = {610},
      cid          = {I:(DE-2719)1111015},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41484430},
      doi          = {10.1007/s00702-025-03096-7},
      url          = {https://pub.dzne.de/record/284361},
}