Factors Associated with Orthostatic Hypotension in Parkinson's Disease Patients: A Systematic Review and Meta-analysis

Summary

This study summarizes and quantifies factors associated with orthostatic hypotension in Parkinson's disease patients.

Abstract

Orthostatic hypotension (OH) is a prevalent non-motor symptom in Parkinson's disease (PD), heightening the risk of falls and mortality. This study aimed to identify and quantify the factors associated with OH in PD patients. A comprehensive search of nine databases, PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), and Wanfang, was conducted, covering articles from database inception to November 27, 2024. Two researchers independently screened titles, abstracts, and full texts, evaluating the methodological quality of the studies. Relevant data were analyzed through meta-analysis using R software. Nineteen studies of moderate to high quality were included. The analysis revealed significant associations between PD-related OH and several independent factors: age (OR = 1.06; 95% CI: 1.05-1.08; I² = 78%; P < 0.01), Hoehn-Yahr stage (H-Y stage) (OR = 1.57; 95% CI: 1.09-2.26; I² = 51%; P = 0.02), Hemoglobin A1c (HbA1c) (OR = 2.08; 95% CI: 1.28-3.38; I² = 0%; P < 0.01), REM Sleep Behavior Disorder (RBD) (OR = 5.83; 95% CI: 2.70-12.61; I² = 24%; P < 0.01), Levodopa-equivalent daily dose (LEDD) (OR = 1.00; 95% CI: 1.00-1.01; I² = 79%; P = 0.06), PD-autonomic dysfunction (SCOPA-AUT) (OR = 1.15; 95% CI: 0.99-1.34; I² = 94%; P = 0.06), and hypertension (OR = 3.86; 95% CI: 1.25-11.90; I² = 71%; P = 0.02). These findings suggest that factors such as age, H-Y stage, HbA1c, LEDD, SCOPA-AUT, hypertension, and RBD are associated with PD-related OH. Further research is essential to refine prevention strategies.

Introduction

Following Alzheimer's disease, Parkinson's disease (PD) is the second most common neurodegenerative disorder in the elderly population¹. Orthostatic hypotension (OH) is prevalent in PD², affecting between 30.1% and 60% of patients^3,4. Despite its high prevalence, OH is often underrecognized and underestimated due to its asymptomatic nature, which complicates detection^5,6. Common symptoms of OH in PD patients include dizziness, blurred vision, and transient loss of consciousness^7<....

Protocol

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines²⁶. It was registered in PROSPERO (CRD42023397565).

1. Software installation

1. R software installation
   1. Visit the official R software website (see Table of Materials). Click Download R for Windows, then select base and click Download. Choose the appropriate platform installation version to download the installation package.
   2. Run the executable file by dou....

Results

This study strictly followed the procedures and methods outlined in the protocol to conduct a meta-analysis. The findings include: (1) the screening of 19 relevant original studies; (2) the completion of quality assessments for these 19 articles; and (3) the extraction and quantitative analysis of 14 influencing factors to explore their correlation with the occurrence of OH in PD patients. The combined results were considered statistically significant at a P value of ≤ 0.05.

Study char.......

Discussion

This study presents a meta-analys is aimed at identifying and quantifying the factors associated with OH in PD patients. The analysis revealed that among 14 factors, age, H-Y stage, HbA1c, LEDD, SCOPA-AUT, hypertension, and RBD were significantly associated with PD-OH. This study further demonstrates a strong association between elevated HbA1c levels and orthostatic hypotension (OH), corroborating previous reports^39,40. The underlying mechan.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
R sofeware	Lucent Technologies	Official Version	R is a  software environment for statistical computing and graphics.R provides a wide variety of statistical and graphical techniques, and is highly extensible.Official website:https://www.r-project.org
Endnote	Clarivate	Official Version	EndNote is a widely used reference management tool to help you collect,organize, and share your references.Official website: https://endnote.com/downloads.
Microsoft Excel	Microsoft	Official Version	Microsoft Excel, a spreadsheet software with an intuitive interface, excellent computing capabilities and charting tools, is one of the most popular data processing software for personal computers.
Microsoft Word	Microsoft	Official Version	Microsoft Word offers a number of easy-to-use document creation tools, as well as a rich set of features for creating complex documents, as well as text formatting or image manipulation.
Database websites
Pubmed			https://pubmed.ncbi.nlm.nih.gov/
Web of Science			http://www.web of science.com/
Scopus			https://www.scopus.com/
Cochrane Library			https://www.cochranelibrary.com/
Embase			https://www.embase.com/
CINAHL			https://www.ebsco.com/zh-cn/products/research-databases/cinahl-database
CNKI			https://www.cnki.net/
CBM			http://www.sinomed.ac.cn/
Wanfang			https://c.wanfangdata.com.cn/