Lewy bodies disease (LBD) is include Parkinson disease, pure autonomic failure, and dementia with Lewy body disease (DLB). Pathologically, the transfer of Lewy bodies to the brain from the peripheral nervous system. 123-I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy demonstrates low uptake in LBD. However, there is a few reports about the circadian variability of blood pressure (BP) in LBD. Recently, we experienced 4 case of LBD with Nocturnal hypertension (NH).
Design and method:
The patients with faintness admitted to Aoyama Hospital, Tokyo Medical University, Japan, who were suspected of autonomic failure. We tested orthostatic vital signs and ambulatory blood pressure monitoring (ABPM) to evaluate BP patterns of circadian variability. Orthostatic hypotension (OH) is diagnosed as a fall in systolic BP of at least 20 mmHg from standing. NH is defined as higher nighttime BP level than daytime BP level. We examined MIBG scintigraphy to discriminate LBD.
Case 1: a-77-year-old woman has faintness in the morning. The average of nighttime BP was 170/86 mmHg and daytime BP was 130/72 mmHg. Case2: a-85-year-old male, the average of nighttime BP was 153/87 mmHg and daytime BP was 125/74 mmHg. Case 3: a-81-year-old male was already diagnosed as DLB. The average of nighttime BP was 161/91 mmHg and daytime BP was 122/76 mmHg. Case 4: a-82-year-old male has been diagnosed with DLB and OH. The average of nighttime BP was 157/85 mmHg and daytime BP was 137/79 mmHg. All cases had OH, BP felled from 145/69 to 108/65 mmHg, from 146/80 to 110/77 mmHg, from 206/110 to 170/103 mmHg and had faintness with low blood pressure 90/60 mmHg, respectively. MIBG up-take was low or absent in all of four patients. Surprisingly, in case 1, Cilnidipine can control nocturnal hypertension and improved orthostatic hypotension.
Our result indicated that nocturnal hypertension and ensuing orthostatic hypotension were excessive BP variability in LBD. ABPM is the beneficial examination for the patients with autonomic failure.