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  • Review Article
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Review series—Hypertension under specific condition

Abnormal circadian blood pressure regulation and cognitive impairment in α-synucleinopathies

Hypertension Research volume 45, pages 1908–1917 (2022)Cite this article

Abstract

Circadian blood pressure (BP) rhythm is important for the maintenance of healthy daily life, and its disruption is associated with poor outcomes. Cardiovascular autonomic failure is often observed in older populations but has a greater impact on neurodegenerative disorders such as α-synucleinopathies. These BP abnormalities include orthostatic hypotension (OH), supine hypertension (SH), and a loss of nocturnal BP fall. OH not only causes falls or syncope but is also related to cognitive impairment in α-synucleinopathies. For example, OH doubles or triples the risk for the development of cognitive impairment in Parkinson’s disease (PD). The diffuse central and peripheral neuropathology of α-synuclein may contribute to both OH and cognitive impairment. Moreover, repeated cerebral hypoperfusion in OH is thought to be related to cerebrovascular and neuronal damage, which may cause cognitive impairment. SH, which often coexists with OH, is also associated with cognitive impairment through cerebrovascular damage, such as white matter lesions and cerebral microbleeds. The reverse-dipping (riser) pattern on ambulatory BP monitoring is commonly observed in PD (∼56%), regardless of disease duration and severity. It is also related to cognitive impairment and more pronounced when coexisting with OH. These abnormal circadian BP profiles may be synergistically associated with cognitive impairment and poor outcomes in α-synucleinopathies. Although evidence for aggressive control of BP dysregulation improving cognitive impairment and outcomes is limited, regular BP monitoring appears to be important for total management of α-synucleinopathies.

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  1. Stroke Center and Division of Neurology, Department of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-shi, Tochigi, 329-0498, Japan

    Ryota Tanaka

  2. Department of Neurology, Juntendo University School of Medicine, Hongo 3311-1, Bunkyo-ku, Tokyo, 113-0011, Japan

    Nobutaka Hattori

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RT has received honoraria from Daiichi Sankyo, Bayer, and Eisai. NH has received consulting fees from Hisamitsu Pharma and PARKINSON Laboratories Co., Ltd., received honoraria from Dai-Nippon Sumitomo Pharma, Kyowa Kirin Co., Ltd., Takeda Pharmaceutical, AbbVie GK, Nippon Boehringer Ingelheim, Otsuka Pharmaceutical, Novartis Pharma, Bristol-Myers Squibb, Ono Pharmaceutical, FP Pharmaceutical, Eisai, Kissei Pharmaceutical, Nihon Medi-physics, and Daiichi Sankyo, and received payment for expert testimony from Dai-Nippon Sumitomo Pharma, Kyowa Kirin Co., Ltd., Takeda Pharmaceutical, TEIJIN PHARMA LIMITED, Novartis Pharma, Ono Pharmaceutical, Biogen Idec Japan, Kissei Pharmaceutical, and Mitsubishi Tanabe Pharma and Expert testimony (Honoraria as a team leader) from RIKEN: Center for Brain Science, and stroke ownership and outside the submitted work from PARKINSON Laboratories Co., Ltd.

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Tanaka, R., Hattori, N. Abnormal circadian blood pressure regulation and cognitive impairment in α-synucleinopathies. Hypertens Res 45, 1908–1917 (2022). https://doi.org/10.1038/s41440-022-01032-w

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