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Questions and Answers

What is the prevalence of nSH in patients with Parkinson's disease?

  • Unknown
  • 48-70%
  • 34-46% (correct)
  • 37%

    • What is the prevalence of nSH in patients with pure autonomic failure (PAF)?

  • 34-46%
  • 37%
  • 48-70% (correct)
  • Unknown

    • What is a common feature in patients with Parkinson's disease and multiple system atrophy?

  • Increased heart rate variability
  • Decreased baroreflex sensitivity
  • Loss of nocturnal blood pressure dipping (correct)
  • Elevated daytime blood pressure

    • What is the relationship between nOH and rising nocturnal BP profiles in patients with diabetes mellitus?

    <p>Significant association</p> Signup and view all the answers

    What is the effect of anti-hypotensive drugs used for the treatment of nOH on nSH?

    <p>May unmask or exacerbate nSH</p> Signup and view all the answers

    What are the contributing factors to nSH?

    <p>Impairment of the afferent, central, and efferent pathways of the arterial baroreflex arch, disruption of the renin-angiotensin-aldosterone axis, and denervation supersensitivity at the level of the vascular adrenoceptors</p> Signup and view all the answers

    What drives nSH in multiple system atrophy?

    <p>Noradrenaline release from intact post-ganglionic sympathetic fibers</p> Signup and view all the answers

    What contributes to nSH in pure autonomic failure?

    <p>Mechanisms independent of the sympathetic autonomic nervous system</p> Signup and view all the answers

    How should patients with nOH be screened for nSH?

    <p>At diagnosis and at regular intervals afterward</p> Signup and view all the answers

    How should office screening for nSH be performed?

    <p>By measuring supine BP as soon as the patient assumes the supine position and then again after the patient has been resting supine for at least 5 minutes</p> Signup and view all the answers

    What is recommended to gather further insights into circadian BP control?

    <p>Home BP recordings performed by patients themselves</p> Signup and view all the answers

    How should a diagnosis of nSH be made in patients with cardiovascular autonomic failure?

    <p>Independently from seated BP values, which may vary</p> Signup and view all the answers

    What is the prevalence of nSH in patients with Parkinson's disease?

    <p>34-46%</p> Signup and view all the answers

    What is the prevalence of nSH in patients with pure autonomic failure (PAF)?

    <p>48-70%</p> Signup and view all the answers

    What is a common feature in patients with Parkinson's disease and multiple system atrophy?

    <p>Loss of nocturnal blood pressure dipping</p> Signup and view all the answers

    What is the relationship between nOH and rising nocturnal BP profiles in patients with diabetes mellitus?

    <p>Significant association</p> Signup and view all the answers

    What is the effect of anti-hypotensive drugs used for the treatment of nOH on nSH?

    <p>May unmask or exacerbate nSH</p> Signup and view all the answers

    What are the contributing factors to nSH?

    <p>Impairment of the afferent, central, and efferent pathways of the arterial baroreflex arch, disruption of the renin-angiotensin-aldosterone axis, and denervation supersensitivity at the level of the vascular adrenoceptors</p> Signup and view all the answers

    What drives nSH in multiple system atrophy?

    <p>Noradrenaline release from intact post-ganglionic sympathetic fibers</p> Signup and view all the answers

    What contributes to nSH in pure autonomic failure?

    <p>Mechanisms independent of the sympathetic autonomic nervous system</p> Signup and view all the answers

    How should patients with nOH be screened for nSH?

    <p>At diagnosis and at regular intervals afterward</p> Signup and view all the answers

    How should office screening for nSH be performed?

    <p>By measuring supine BP as soon as the patient assumes the supine position and then again after the patient has been resting supine for at least 5 minutes</p> Signup and view all the answers

    What is recommended to gather further insights into circadian BP control?

    <p>Home BP recordings performed by patients themselves</p> Signup and view all the answers

    How should a diagnosis of nSH be made in patients with cardiovascular autonomic failure?

    <p>Independently from seated BP values, which may vary</p> Signup and view all the answers

    What percentage of patients with Parkinson's disease have nocturnal supine hypertension (nSH)?

    <p>34-46%</p> Signup and view all the answers

    What is the prevalence of nSH in pure autonomic failure (PAF)?

    <p>48-70%</p> Signup and view all the answers

    What is a common feature of nocturnal blood pressure (BP) in patients with Parkinson's disease (PD) and multiple system atrophy (MSA)?

    <p>Decrease in BP</p> Signup and view all the answers

    What is the significant association between nOH and nocturnal BP profiles in patients with diabetes mellitus?

    <p>Rising BP profiles</p> Signup and view all the answers

    What is the effect of anti-hypotensive drugs used for the treatment of nOH on nSH?

    <p>Unmasks or exacerbates nSH</p> Signup and view all the answers

    What are the multiple factors that contribute to nSH?

    <p>Impairment of the afferent, central, and efferent pathways of the arterial baroreflex arch, disruption of the renin-angiotensin-aldosterone axis, and denervation supersensitivity at the level of the vascular adrenoceptors</p> Signup and view all the answers

    What drives nSH in multiple system atrophy (MSA)?

    <p>Noradrenaline release from intact post-ganglionic sympathetic fibers</p> Signup and view all the answers

    How should office screening for nSH be performed?

    <p>By measuring BP as soon as the patient assumes the supine position and then again after the patient has been resting supine for at least 5 minutes</p> Signup and view all the answers

    What is recommended to gather further insights into circadian BP control?

    <p>24-hour ambulatory BP monitoring recordings</p> Signup and view all the answers

    How should a diagnosis of nSH be made in patients with cardiovascular autonomic failure?

    <p>Based on supine BP values</p> Signup and view all the answers

    What are the cut-offs for nSH diagnosis in the context of cardiovascular autonomic failure based on?

    <p>The criteria for the diagnosis of essential hypertension</p> Signup and view all the answers

    What is the prevalence of nSH in patients with multiple system atrophy (MSA)?

    <p>34-46%</p> Signup and view all the answers

    Study Notes

    Diagnosis and Management of Nocturnal Supine Hypertension in Cardiovascular Autonomic Failure

    • Nocturnal supine hypertension (nSH) is present in 34-46% of patients with Parkinson's disease (PD) and 37% of patients with multiple system atrophy (MSA).
    • Loss of nocturnal blood pressure (BP) dipping is common in PD and MSA patients.
    • The prevalence of nSH in pure autonomic failure (PAF) ranges from 48-70%.
    • There is a significant association between the presence of nOH and rising nocturnal BP profiles in patients with type 1 and type 2 diabetes mellitus.
    • Anti-hypotensive drugs used for the treatment of nOH may unmask or exacerbate nSH.
    • Multiple factors contribute to nSH, including impairment of the afferent, central, and efferent pathways of the arterial baroreflex arch, disruption of the renin-angiotensin-aldosterone axis, and denervation supersensitivity at the level of the vascular adrenoceptors.
    • Noradrenaline release from intact post-ganglionic sympathetic fibers drives nSH in MSA, while mechanisms independent of the sympathetic autonomic nervous system contribute to nSH in PAF.
    • Patients with nOH should be screened for nSH at diagnosis and at regular intervals afterward.
    • Office screening for nSH should be performed by measuring supine BP as soon as the patient assumes the supine position and then again after the patient has been resting supine for at least 5 minutes.
    • Home BP recordings performed by patients themselves are recommended to gather further insights into circadian BP control.
    • A diagnosis of nSH should be made independently from seated BP values, which may vary in patients with cardiovascular autonomic failure.
    • Cut-offs for nSH diagnosis in the context of cardiovascular autonomic failure are based on the criteria for the diagnosis of essential hypertension and interpretation of 24-hour ambulatory BP monitoring recordings in the general population.

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    Description

    Test your knowledge on the diagnosis and management of nocturnal supine hypertension in cardiovascular autonomic failure with this informative quiz. Learn about the prevalence of nSH in various conditions, the contributing factors, and screening methods. Explore how anti-hypotensive drugs can impact nSH and the importance of independent diagnosis. This quiz is ideal for healthcare professionals and students interested in cardiovascular autonomic failure and hypertension.

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