Orthostatic blood pressure trajectories characterize heterogeneous disease progression in Parkinson's disease

Identifying biomarkers that reflect disease progression in Parkinson's disease (PD) is of substantial clinical relevance. Accumulating evidence suggests a potential link between orthostatic hypotension and disease progression in PD. However, prior studies have largely relied on single baseline assessments, thereby overlooking longitudinal fluctuations in orthostatic blood pressure changes.

This study aimed to identify distinct longitudinal trajectories of orthostatic systolic blood pressure change (∆SBP) and to investigate their associations with disease progression in PD.

A total of 1,081 PD patients were included from two independent cohorts. Latent class trajectory model was applied to delineate longitudinal ∆SBP trajectories. Cox proportional hazards models and linear mixed-effects models were used to evaluate the associations between ∆SBP trajectories and clinical progression.

Two latent class of ∆SBP trajectories were identified: a low-stable trajectory and an increasing trajectory. Compared with the low-stable class, patients in the increasing ∆SBP trajectory exhibited a higher risk of developing cognitive impairment, along with faster decline in visuospatial, attentional, and executive functions. They also showed more severe motor symptoms and rapid eye movement sleep behavior disorder, as well as accelerated progression of autonomic dysfunction and impairment in activities of daily living.

An increasing ∆SBP trajectory was associated with a more pronounced progression across multiple clinical domains in PD, suggesting that longitudinal orthostatic blood pressure patterns may represent a clinically relevant dimension of disease heterogeneity.