Reverse Dipping Blood Pressure Common for Inpatients with Advanced Parkinson’s Disease

Inpatients with Parkinson’s disease (PD) have been observed to exhibit reverse dipping, in which nocturnal systolic blood pressure (BP) rises, according to study results published in Brain and Behavior.

Blood pressure abnormalities can lead to decreased cerebral blood flow and manifest as symptoms of dizziness, blurred vision, falls, and syncope. Long-term abnormalities increase the risk of cardiovascular events. The aim of the current study was to analyze changes in blood pressure using 24-hour ambulatory blood pressure monitoring in patients with Parkinson’s disease in different disease stages and subtypes.

Between 2017 and 2020, inpatients (N=75) from Shanghai Fifth People’s Hospital in China were included in this study. Study participants were assessed by a 24-hour ambulatory blood pressure measurement. Normal immersion was defined as a 10%-19% reduction, reduced immersion as a 0%-9% reduction, and reverse immersion as nocturnal rise in systolic blood pressure. Blood pressure patterns were compared between inpatients with Parkinson’s disease (n=32) and inpatients with benign paroxysmal positional vertigo and chronic subjective vertigo (n=43).

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Mean age of patients with Parkinson’s disease and controls was 72.7 ± 9.8 and 68.7 ± 10.1 years, male:female ratios were 17:15 and 20:23, 68.8% and 65, respectively. 1% had hypertension and 15.6% and 20.9% had diabetes, respectively.

In the PD and control cohorts, 24-hour systolic BP (mean 134.4 vs. 132.7 mmHg; P=0.723) and diastolic BP (mean 74.1 vs. 75.4 mmHg; P=0.577) differed ) not between the groups. All other blood pressure measurements did not differ between groups, with the exception of nocturnal systolic blood pressure, which was higher in the PD cohort (mean 140.2 vs. 127.5 mmHg; p=0.027).

Most patients in the control cohort had non-decreasing blood pressure (51.2%) compared to 31.3% in the PD group (p<0.001). Most patients in the PD cohort had reverse dipping (65.6%) compared to 20.9% in the control cohort.

Stratified by early (n=11) and advanced (n=21) PD, the advanced PD group had an elevated mean nocturnal systolic blood pressure (146.9 ± 26.4 mmHg) compared to the early PD (127.4 ± 24 .1 mmHg) and control (127.5 ±21.8 mmHg; P=0.008) groups. A similar pattern was observed for nocturnal diastolic blood pressure (mean 80.1 vs. 70.3 vs. 71.4 mmHg; p=0.013).

Among the PD cohort alone, 71.4% of patients with early PD were non-dippers and 81.0% of patients with advanced PD were reverse-dippers (p=0.009). These two cohorts did not differ in mean blood pressure, but in the coefficients of variation of systolic (15.7% vs. 12.1%) and diastolic (17.5% vs. 11.7%; P = 0.005) blood pressure.

No significant differences in blood pressure trends were observed based on tremor status.

Stratified by reverse-dipping status, the only group difference was the age at which non-dippers were younger (mean 67.3 vs. 75.0 years; P=0.041).

This study was limited by not including other Parkinson’s symptoms, such as multiple system atrophy, to better assess whether symptomology was partially responsible for reverse dipping.

This study found that reverse dipping was more common in patients with advanced Parkinson’s disease and did not appear to be related to tremor symptoms. “24-hour ambulatory blood pressure monitoring is an important method for assessing blood pressure changes in Parkinson’s disease patients,” the researchers explained. “Clinicians should be aware of reverse dipping in PD patients and intervene to prevent serious clinical events.”


Shen L, Yang X, Lu W, Chen W, Ye X, Wu D. Ambulatory 24-hour blood pressure changes in patients with Parkinson’s disease. Brain Behavior Published Online 28 November 2021. doi:10.1002/brb3.2428

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