Ambulatory Episodic Hypertension in Parkinson's Disease With Orthostatic Hypotension

OBJECTIVE: The objective of this study was to determine whether ambulatory hypertensive episodes are associated with clinical outcomes in patients with Parkinson's disease (PD) with neurogenic versus non-neurogenic orthostatic hypotension. METHODS: Consecutive patients with PD with suspected orthostatic hypotension (OH) underwent 24-hour ambulatory blood pressure monitoring in the home setting. The primary exposure was the number of hypertensive episodes across 24 hours. Neurogenic OH was defined by a heart rate response to orthostatic systolic blood pressure reduction of <0.5 beats/min/mmHg during standardized 3-minute orthostatic testing. The primary outcome was quality of life measured by the Parkinson's Disease Questionnaire-39 Summary Index (PDQ-39 SI). Secondary outcomes included orthostatic symptom burden and motor severity. Multivariable linear regression models with interaction terms were adjusted for age, sex, disease duration, and levodopa equivalent daily dose, with robustness assessed through multiple sensitivity analyses. RESULTS: Fifty-nine patients with PD were included, 30 with neurogenic OH and 29 with non-neurogenic orthostatic hypotension. Among patients with neurogenic OH, a greater number of hypertensive episodes was associated with better quality of life, lower orthostatic symptom burden, and lower motor impairment scores. In patients with non-neurogenic OH, these associations were absent or occurred in the opposite direction. Associations were stronger during daytime than night-time periods and remained consistent in sensitivity analyses. INTERPRETATION: In patients with PD and neurogenic OH, ambulatory hypertensive episodes were associated with better clinical outcomes, an association not observed in patients with non-neurogenic OH. ANN NEUROL 2026.