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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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