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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},
}