ArticleAnnals of neurology2018
Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies.
Article in Annals of neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01799915 (Natural History Study of Synucleinopathies), which is not on this map. Cited by 135 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Natural History Study of Synucleinopathies
Who cites it
135 citing papers in PubMed, 3 syntheses or guidelines pooled it, 228 citations in OpenAlex.
- Diagnosis and treatment of autonomic failure, pain and sleep disturbances in Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology.Journal of neurology · 2025Guideline
- The Movement Disorder Society Criteria for the Diagnosis of Multiple System Atrophy.Movement disorders : official journal of the Movement Disorder Society · 2022Pooled it
- Management of Hypertension and Blood Pressure Dysregulation in Patients with Parkinson's Disease-a Systematic Review.Current hypertension reports · 2021Pooled it
- Mechanism-Based Therapy With Ampreloxetine for Neurogenic Orthostatic Hypotension in Multiple System Atrophy: A Randomized Withdrawal Trial.Neurology · 2026Trial
- Clinical Correlates of Efficacy of Pyridostigmine in the Treatment of Orthostatic Hypotension.Hypertension (Dallas, Tex. : 1979) · 2025Trial
- Safety and efficacy of ampreloxetine in symptomatic neurogenic orthostatic hypotension: a phase 2 trial.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2021Trial
- Cardiovascular Autonomic Neuropathy in Charcot-Marie-Tooth Disease: A Genotype-Stratified Study of PMP22 Duplication and GJB1 Mutation Carriers.Journal of the peripheral nervous system : JPNS · 2026Article
- Greater Motor and Nonmotor Burden at Diagnosis Is Associated With Amyloid Copathology in Parkinson's Disease.Movement disorders : official journal of the Movement Disorder Society · 2026Article
- Levodopa-induced dyskinesia is associated with worse gait and balance in Parkinson's disease.Journal of neural transmission (Vienna, Austria : 1996) · 2026Article
- Elevated plasma neurofilament light chain in isolated REM sleep behavior disorder: Associations with neurogenic orthostatic hypotension and implications for phenoconversion.Journal of Parkinson's disease · 2026Article
- Clinical Significance of Thyroid 123I- Meta-Iodobenzylguanidine Uptake in Parkinson's Disease.Journal of movement disorders · 2026Article
- Synucleinopathy-like clinical features and biologically defined synuclein seeding in PSP-Parkinsonism: an imperfect match.NPJ Parkinson's disease · 2026Article
- Acute myocardial infarction in a patient with HAM/TSP evaluated for circulatory dynamics during mobilization before and after antihypertensive drug modification: a case report.Journal of medical case reports · 2026Article
- Distinct Sympathoneural and Cardiovagal Domains of Arterial Baroreflex Function in Autonomic Synucleinopathies.Research square · 2026Article
- Early Autonomic Burden in Prodromal Parkinson's Disease Predicts Cognitive Impairment.Movement disorders : official journal of the Movement Disorder Society · 2026Article
- Revealing Non-Motor Symptom Profiles of Orthostatic Hypotension Subtypes in Parkinson's Disease: Insights From a Multidimensional Case-Control Study.Clinical and translational science · 2026Article
- How to treat cardiovascular autonomic failure in Parkinson's disease.Journal of neural transmission (Vienna, Austria : 1996) · 2026Review
- Locus coeruleus degeneration is associated with orthostatic hypotension in Parkinson's disease and multiple system atrophy.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- Cardiovascular autonomic failure correlates with cutaneous autonomic denervation in PD and MSA.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- Delayed Cardiovascular Response to Acute Hypotension in Heart Failure Patients Compared to Healthy Adults.International journal of vascular medicine · 2026Article
75 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveBlunted tachycardia during hypotension is a characteristic feature of patients with autonomic failure, but the range has not been defined. This study reports the range of orthostatic heart rate (HR) changes in patients with autonomic failure caused by neurodegenerative synucleinopathies.
methodsPatients evaluated at sites of the U.S. Autonomic Consortium (NCT01799915) underwent standardized autonomic function tests and full neurological evaluation.
resultsWe identified 402 patients with orthostatic hypotension (OH) who had normal sinus rhythm. Of these, 378 had impaired sympathetic activation (ie, neurogenic OH) and based on their neurological examination were diagnosed with Parkinson disease, dementia with Lewy bodies, pure autonomic failure, or multiple system atrophy. The remaining 24 patients had preserved sympathetic activation and their OH was classified as nonneurogenic, due to volume depletion, anemia, or polypharmacy. Patients with neurogenic OH had twice the fall in systolic blood pressure (SBP; -44 ± 25 vs -21 ± 14 mmHg [mean ± standard deviation], p < 0.0001) but only one-third of the increase in HR of those with nonneurogenic OH (8 ± 8 vs 25 ± 11 beats per minute [bpm], p < 0.0001). A ΔHR/ΔSBP ratio of 0.492 bpm/mmHg had excellent sensitivity (91.3%) and specificity (88.4%) to distinguish between patients with neurogenic from nonneurogenic OH (area under the curve = 0.96, p < 0.0001). Within patients with neurogenic OH, HR increased more in those with multiple system atrophy (p = 0.0003), but there was considerable overlap with patients with Lewy body disorders.
interpretationA blunted HR increase during hypotension suggests a neurogenic cause. A ΔHR/ΔSBP ratio < 0.5 bpm/mmHg is diagnostic of neurogenic OH. Ann Neurol 2018;83:522-531.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.