Ambulatory blood pressure and drug treatment for orthostatic hypotension as predictors of mortality in patients with multiple system atrophy
Corresponding Author
Anne Pavy-Le Traon
Neurology Department University Hospital of Toulouse and INSERM UMR 1297, French Reference Center for Multiple System Atrophy, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
Correspondence
Anne Pavy-Le Traon, French Reference Center for Multiple System Atrophy, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac – TSA 40 031, 31059 – Toulouse cedex 9 – France.
Email: [email protected]
Contribution: Conceptualization (equal), Data curation (lead), Formal analysis (equal), Investigation (lead), Methodology (supporting), Supervision (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorAlexandra Foubert-Samier
CRMR AMS, Service de Neurologie – Maladies Neurodégénératives, CHU de Bordeaux, Bordeaux, France
Contribution: Formal analysis (supporting), Methodology (supporting), Writing - review & editing (supporting)
Search for more papers by this authorFabienne Ory-Magne
Neurology Department University Hospital of Toulouse, Clinical Investigation Center CIC 1436, Parkinson Expert Centre, French Reference Center for Multiple System Atrophy, NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse, CHU of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
Contribution: Investigation (supporting), Writing - review & editing (supporting)
Search for more papers by this authorMargherita Fabbri
Neurology Department University Hospital of Toulouse, Clinical Investigation Center CIC 1436, Parkinson Expert Centre, French Reference Center for Multiple System Atrophy, NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse, CHU of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
Contribution: Writing - review & editing (supporting)
Search for more papers by this authorJean-Michel Senard
Department of Clinical Pharmacology, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse University Hospital and INSERM UMR 1297, Toulouse, France
Contribution: Investigation (supporting), Writing - review & editing (supporting)
Search for more papers by this authorWassilios G. Meissner
CRMR AMS, Service de Neurologie – Maladies Neurodégénératives, CHU de Bordeaux, Bordeaux, France
CNRS, IMN, UMR 5293, Univ. Bordeaux, Bordeaux, France
Department of Medicine, New Zealand Brain Research Institute, University of Otago, Christchurch, New Zealand
Contribution: Formal analysis (supporting), Writing - original draft (supporting), Writing - review & editing (supporting)
Search for more papers by this authorOlivier Rascol
French Reference Center for Multiple System Atrophy, Clinical Investigation Center CIC1436, Department of Clinical Pharmacology and Neurosciences, NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse, CHU of Toulouse, INSERM and University of Toulouse 3, Toulouse, France
Contribution: Formal analysis (supporting), Writing - original draft (supporting), Writing - review & editing (supporting)
Search for more papers by this authorJacques Amar
Department of arterial hypertension, European Society of Hypertension Excellence Center, INSERM UMR 1047, Toulouse University, Toulouse, France
Contribution: Conceptualization (equal), Formal analysis (equal), Methodology (lead), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorCorresponding Author
Anne Pavy-Le Traon
Neurology Department University Hospital of Toulouse and INSERM UMR 1297, French Reference Center for Multiple System Atrophy, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
Correspondence
Anne Pavy-Le Traon, French Reference Center for Multiple System Atrophy, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac – TSA 40 031, 31059 – Toulouse cedex 9 – France.
Email: [email protected]
Contribution: Conceptualization (equal), Data curation (lead), Formal analysis (equal), Investigation (lead), Methodology (supporting), Supervision (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorAlexandra Foubert-Samier
CRMR AMS, Service de Neurologie – Maladies Neurodégénératives, CHU de Bordeaux, Bordeaux, France
Contribution: Formal analysis (supporting), Methodology (supporting), Writing - review & editing (supporting)
Search for more papers by this authorFabienne Ory-Magne
Neurology Department University Hospital of Toulouse, Clinical Investigation Center CIC 1436, Parkinson Expert Centre, French Reference Center for Multiple System Atrophy, NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse, CHU of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
Contribution: Investigation (supporting), Writing - review & editing (supporting)
Search for more papers by this authorMargherita Fabbri
Neurology Department University Hospital of Toulouse, Clinical Investigation Center CIC 1436, Parkinson Expert Centre, French Reference Center for Multiple System Atrophy, NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse, CHU of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
Contribution: Writing - review & editing (supporting)
Search for more papers by this authorJean-Michel Senard
Department of Clinical Pharmacology, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse University Hospital and INSERM UMR 1297, Toulouse, France
Contribution: Investigation (supporting), Writing - review & editing (supporting)
Search for more papers by this authorWassilios G. Meissner
CRMR AMS, Service de Neurologie – Maladies Neurodégénératives, CHU de Bordeaux, Bordeaux, France
CNRS, IMN, UMR 5293, Univ. Bordeaux, Bordeaux, France
Department of Medicine, New Zealand Brain Research Institute, University of Otago, Christchurch, New Zealand
Contribution: Formal analysis (supporting), Writing - original draft (supporting), Writing - review & editing (supporting)
Search for more papers by this authorOlivier Rascol
French Reference Center for Multiple System Atrophy, Clinical Investigation Center CIC1436, Department of Clinical Pharmacology and Neurosciences, NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse, CHU of Toulouse, INSERM and University of Toulouse 3, Toulouse, France
Contribution: Formal analysis (supporting), Writing - original draft (supporting), Writing - review & editing (supporting)
Search for more papers by this authorJacques Amar
Department of arterial hypertension, European Society of Hypertension Excellence Center, INSERM UMR 1047, Toulouse University, Toulouse, France
Contribution: Conceptualization (equal), Formal analysis (equal), Methodology (lead), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorAbstract
Objectives
Multiple system atrophy (MSA) is a rare fatal neurodegenerative disease characterized by parkinsonism, cerebellar ataxia and autonomic failure. This study was aimed at investigating possible associations between mortality, 24-h blood pressure (BP) level and variability, and drug treatments for orthostatic hypotension (OH) in MSA patients.
Methods
A total of 129 patients followed at the French Reference Center for MSA who underwent routine 24-h ambulatory BP monitoring were included. Unified MSA Rating Scale (UMSARS) scores, drug treatments and the occurrence and cause of death were recorded.
Results
Seventy patients died during follow-up (2.9 ± 1.8 years), mainly from terminal illness, pulmonary or sudden death. Multivariate Cox regression analysis, after adjustment for gender, disease duration and severity (UMSARS I+II score), showed that increased daytime systolic BP variability, OH severity and OH drug treatment were independently correlated with mortality. OH treatment was associated with the risk of cardiac causes and/or sudden death (p = 0.01). In a fully adjusted model, male gender [(female vs. male) hazard ratio (HR) 0.56, 95% CI 0.34–0.94, p = 0.03], UMSARS I+II score (HR 1.04, 95% CI 1.02–1.06, p < 0.01), systolic BP daytime variability (HR 3.66, 95% CI 1.46–9.17, p < 0.01) and OH treatment (HR: 2.13, 95% CI 1.15–3.94, p = 0.02) predicted mortality.
Conclusions
Increased daytime BP variability and OH treatment were predictive of mortality in patients with MSA, independently from disease severity. Further studies are required to assess if these associations are explained by more severe autonomic dysfunction or if OH treatment exposes per se to a specific risk in this population.
CONFLICT OF INTEREST
None of the authors has a conflict of interest for this study.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings from this study are not publicly available. They may be obtained from the corresponding author upon reasonable request wherever legally and ethically possible.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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