Cardiovascular autonomic failure, mortality and end-organ damage: evidence from the literature

      Cardiovascular failure in α-synucleinopathies is cdommon. Orthostatic hypotension (OH) is usually the prominent clinical symptom. During the course of disease, OH usually progresses but is controllable employing non-pharmacological and pharmacological aids to increase blood pressure. An important side effect of treatments is supine hypertension. The clinical relevance of supine hypertension in patients with autonomic failure has yet to be elucidated. In general nocturnal non-dipping of blood pressure has been associated with increased frequency of cerebrovascular and cardiovascular events. The aim of this talk is to present complications of cardiovascular autonnomic failure and to discuss literature on mortality and end-organ damage. Results: Consequences of OH vary from minor symptoms to syncope, falls, cerebral, or vascular events. Whether OH patients suffer from a higher mortality rate is still under discussion. While earlier assessements reported a similar mortality rate in OH patients, newer data with a considerably longer oberservation period did show an increased mortality in systolic OH (Freud et al., 2015). Evenmore end-organ damage is under controversy and only few data exist. In fact, there is evidence that end organ damage does occur with left-ventricular hypertrophy, renal impairment and above 160 mmHg risk of cerebrovascular events and white matter lesions. Conclusions: OH patients seem to suffer a slightly higher mortality, but results are still under controversy. Autonomic treatment is often hampered by the fear to increase supine hypertension and therefore end-organ damage. However, end-organ damage is unfrequent. Evenmore, it is suggested to consider life expectance of the primary.
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