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INTRODUÇÃO: A hipotensão ortostática e a hipertensão de decúbito são manifestações comuns de disautonomia cardiovascular presentes em pacientes com doença de Parkinson, ou outras sinucleinopatias, e neuropatias periféricas como neuropatia amilóide ou diabética. O tratamento de uma das condições incorre no agravamento da contrária, dado o seu caráter hemodinamicamente oposto. Até recentemente, nenhum critério consensual havia sido definido para o diagnóstico de hipertensão de decúbito, limitando a compreensão atual de sua epidemiologia, prognóstico e, em última análise, tratamento. Apesar do comprovado aumento da morbidade e mortalidade cardiovascular, a longo prazo, associado à hipertensão arterial essencial, não existem dados epidemiológicos sobre as consequências cerebrovasculares da hipertensão de decúbito isolada. OBJETIVO: O objetivo deste trabalho foi avaliar sistematicamente o risco de eventos cerebrovasculares em pacientes com hipertensão de decúbito. MÉTODOS: Foi realizada uma pesquisa eletrónica (Medline, Embase e Central) que integrou dados publicados até outubro de 2020, utilizando os termos hipertensão supina, doenças cerebrovasculares, acidente vascular cerebral e lesão de órgão-alvo. Foram considerados elegíveis estudos que incluíram pacientes com disfunção autonómica, primária relacionada a doenças neurodegenerativas ou secundária a doenças sistêmicas. Não foram definidas restrições quanto ao ano de publicação. Estudos sem definição explícita e bem delineada de hipertensão de decúbito foram excluídos. O outcome primário foi a morbidade cerebrovascular e o outcome secundário a mortalidade por todas as causas. RESULTADOS: Foram incluídos 7 artigos, todos estudos observacionais: 3 estudos casecontrol, 2 cross-sectional, 1 cohort study e 1 case report (594 indivíduos). A hipertensão de decúbito, nos pacientes com disfunção autonómica, parece estar associada a maior carga de lesão de órgãos-alvo, como lesões cerebrovasculares. A heterogeneidade das caraterísticas dos estudos integrados impossibilitou a realização de uma meta-análise formal. CONCLUSÕES: Dados relativos à incidência ou prevalência de eventos cerebrovasculares adversos em pacientes com diagnóstico de hipertensão de decúbito, são escassos. Estudos longitudinais de maiores dimensões, com avaliações padronizadas, são imprescidiveis para averiguar quais os riscos de morbidade e mortalidade relacionados com esta entidade.
BACKGROUND: Neurogenic orthostatic hypotension (nOH) and neurogenic supine hypertension (nSH) are common manifestations of cardiovascular dysautonomia present in patients with Parkinson's disease and associated synucleinopathies and peripheral neuropathies, as amyloid or diabetic neuropathy. Improvement in one of these disorders may be achieved at the expense of worsening the other, considering that they are hemodynamic opposite diseases. Until recently, no consensus criteria had been defined for the diagnosis of nSH, limiting current understanding of its epidemiology, prognosis and, ultimately, treatment. Despite the explicit increased long term cardiovascular morbidity and mortality associated with even mild degrees of arterial hypertension, there are virtually no epidemiologic data on the cerebrocardiovascular consequences of isolated nSH. AIMS: The objective of this study was to systematically evaluate the literature published concerning cerebrovascular events in patients diagnosed with nSH. METHODS: An electronic literature search was performed on Medline, Embase and Central from database inception to October 2020 using the terms supine hypertension, cerebrovascular disorders, stroke, and end-organ damage. We considered eligible studies that included patients with autonomic dysfunction, primary related to neurodegenerative disorders or secondary to systemic illnesses. There were no restrictions regarding the year of publication. Studies without specific and well outlined definition of nSH were excluded. The primary outcome was cerebrovascular morbidity and secondary outcomes were all-cause mortality outcomes RESULTS: There were 7 articles included, all observational studies: 3 case control studies, 2 cross-sectional studies, 1 cohort study and 1 case report (594 subjects). NSH in patients with autonomic dysfunction appears to be associated with a higher burden of target organ damage, such as cerebrovascular lesions and may increase the risk of cardiovascular adverse events and shorter survival. The heterogeneity of the study designs did not allow conducting a formal meta-analysis. Data concerning the frequency of occurrence and causal relationships of the events were nonrobust. CONCLUSIONS: There is no robust data concerning the incidence or prevalence of adverse cerebrovascular events in patients diagnosed with nSH. Larger longitudinal studies with standardized follow-up assessments are required to access the morbidity and mortality risks related with nOH and nSH, and calculation of benefit of effective management.
BACKGROUND: Neurogenic orthostatic hypotension (nOH) and neurogenic supine hypertension (nSH) are common manifestations of cardiovascular dysautonomia present in patients with Parkinson's disease and associated synucleinopathies and peripheral neuropathies, as amyloid or diabetic neuropathy. Improvement in one of these disorders may be achieved at the expense of worsening the other, considering that they are hemodynamic opposite diseases. Until recently, no consensus criteria had been defined for the diagnosis of nSH, limiting current understanding of its epidemiology, prognosis and, ultimately, treatment. Despite the explicit increased long term cardiovascular morbidity and mortality associated with even mild degrees of arterial hypertension, there are virtually no epidemiologic data on the cerebrocardiovascular consequences of isolated nSH. AIMS: The objective of this study was to systematically evaluate the literature published concerning cerebrovascular events in patients diagnosed with nSH. METHODS: An electronic literature search was performed on Medline, Embase and Central from database inception to October 2020 using the terms supine hypertension, cerebrovascular disorders, stroke, and end-organ damage. We considered eligible studies that included patients with autonomic dysfunction, primary related to neurodegenerative disorders or secondary to systemic illnesses. There were no restrictions regarding the year of publication. Studies without specific and well outlined definition of nSH were excluded. The primary outcome was cerebrovascular morbidity and secondary outcomes were all-cause mortality outcomes RESULTS: There were 7 articles included, all observational studies: 3 case control studies, 2 cross-sectional studies, 1 cohort study and 1 case report (594 subjects). NSH in patients with autonomic dysfunction appears to be associated with a higher burden of target organ damage, such as cerebrovascular lesions and may increase the risk of cardiovascular adverse events and shorter survival. The heterogeneity of the study designs did not allow conducting a formal meta-analysis. Data concerning the frequency of occurrence and causal relationships of the events were nonrobust. CONCLUSIONS: There is no robust data concerning the incidence or prevalence of adverse cerebrovascular events in patients diagnosed with nSH. Larger longitudinal studies with standardized follow-up assessments are required to access the morbidity and mortality risks related with nOH and nSH, and calculation of benefit of effective management.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Keywords
Supine hypertension Nocturnal hypertension Autonomic failure End-organ damage Acidente vascular cerebral Cerebrovascular event