People with myasthenia gravis (MG) show significant changes in blood pressure variability both at rest and in response to orthostatic stress, found a new study published in the journal Neurological Sciences. The changes are related to autonomic symptoms and disease severity.

The researchers said that their findings underscore the importance of monitoring blood pressure variability and its evolution over the course of the disease when evaluating cardiovascular autonomic function of patients with MG.

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The aim of the study team was to measure beat-to-beat blood pressure variability during a head-up tilt test in patients with MG with mild and moderate disease and compare the findings to healthy controls to see whether this variability may be associated with autonomic symptom severity.

The researchers analyzed a total of 80 people. Of those, 50 had MG and 30 were healthy volunteers. The patients with MG were further divided into 2 groups as having mild or moderate disease based on the Myasthenia Gravis Foundation of America classification.

The results showed that in patients with moderate MG the sympathovagal balance shifted toward sympathetic predominance, both at rest and during the head-up tilt test.

These patients also had lower values of high-frequency diastolic blood pressure variability during the head-up tilt test, compared to healthy controls and people with mild MG.

Finally, they had higher resting low-frequency diastolic blood pressure variability, more autonomic symptoms, and higher orthostatic intolerance scores than patients with mild MG. 

When they compared patients with mild MG to healthy controls, the researchers found that patients had lower delta mean blood pressure and delta diastolic blood pressure. 

They said that autonomic symptoms were associated with lower blood pressure values, at rest and during the head-tilt test, and lower low-frequency blood pressure variability parameters during the test.

“Our observations highlight possible development of [autonomic symptom] dysregulation, including greater [orthostatic intolerance] symptoms with disease progression,” the authors concluded.


Zawadka-Kunikowska M, Rzepiński Ł, Cieślicka M, et al. Alterations in short-term blood pressure variability related to disease severity and autonomic symptoms in myasthenia gravis patients. Neurol Sci. Published online June 28, 2023. doi:10.1007/s10072-023-06927-1