Heat-related morbidity in patients with orthostatic hypotension and primary autonomic failure
✍ Scribed by Atul Pathak; Maryse Lapeyre-Mestre; Jean-Louis Montastruc; Jean-Michel Senard
- Publisher
- John Wiley and Sons
- Year
- 2005
- Tongue
- English
- Weight
- 98 KB
- Volume
- 20
- Category
- Article
- ISSN
- 0885-3185
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✦ Synopsis
Abstract
We investigated the effects of high‐external‐temperature exposure on neurogenic orthostatic hypotension (OH). Thirty‐one patients with autonomic failure (AF) and pharmacologically treated OH related to probable multiple‐system atrophy (n = 7), Parkinson's disease (n = 10), pure autonomic failure (n = 7), and diffuse Lewy body disease (n = 7) and 26 parkinsonians without AF were included. Prevalence and severity of clinical events were studied during the August 2003 heat wave and the 2004 summer. The prevalence of OH‐related events was significantly higher in 2003 [45.1 vs. 11.5%; P = 0.0052; OR = 6.31 (1.35–33.53)] and 2004 [42.3 vs. 12.0%; P = 0.014; OR = 5.40 (1.28–22.68)] in AF than in controls. The mean severity score for clinical events was significantly higher in AF than in controls during 2003 heat wave (1.2 ± 1.4 vs. 0.2 ± 0.5) but similar in summer 2004 (0.7 ± 1.0 vs. 0.1 ± 0.3). Severe events (unusual home care, assistance, or hospitalization) were only observed in AF patients. A nonstatistically significant higher prevalence of clinical events was observed in AF patients prescribed fludrocortisone (66.7%) by comparison to heptaminol (42.9%), midodrine (45.5%), or midodrine plus fludrocortisone (28.6%). This study shows that AF patients have a poor clinical outcome when exposed to high temperatures and that heat exposure is a risk factor for OH worsening. © 2005 Movement Disorder Society