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- Title
Effect of levodopa on postural blood pressure changes in Parkinson disease: a randomized crossover study.
- Authors
Earl, Timi; Jridi, Amani; Thulin, Perla C.; Zorn, Meghan; McKee, Kathleen E.; Mitrovich, Kristin; Moretti, Paolo; Alshaikh, Jumana; Kassavetis, Panagiotis; Cortez, Melissa M.; Lamotte, Guillaume
- Abstract
Purpose: We investigated the effect of levodopa on postural blood pressure changes in individuals with Parkinson disease (PD) with (PD+OH) and without neurogenic OH (PD−OH). Methods: We performed a prospective randomized crossover study with autonomic testing performed ON and OFF levodopa. The primary outcome was the change in systolic blood pressure (SBP) from supine to 70° tilt at 3 min (ΔSBP-3'). Secondary outcomes included indices of baroreflex function and blood pressure and heart rate during tilt. Results: We enrolled 40 individuals with PD (21 PD+OH, 19 PD−OH), mean age (SD) 73.2 years (7.9), 13 women (32.5%)). There was no difference in age, sex, disease duration, and severity between PD+OH and PD−OH. Mean difference in ΔSBP-3' ON versus OFF levodopa in the whole study population was − 3.20 mmHg [− 7.36 to 0.96] (p = 0.14). Mean difference in ΔSBP-3' was − 2.14 mmHg [− 7.55 to 3.28] (p = 0.45) in PD+OH and − 5.14 mmHg [− 11.63 to 1.35] (p = 0.14) in PD−OH. Mean difference in ΔSBP ON versus OFF levodopa was greater at 7 and 10 min (− 7.52 mmHg [− 11.89 to − 3.15], p = 0.002, and − 7.82 mmHg [− 14.02 to − 1.67], p = 0.02 respectively). Levodopa was associated with lower absolute values of blood pressure in both PD+OH and PD−OH and cardiovascular noradrenergic baroreflex impairment. Conclusion: Levodopa decreases blood pressure in both PD with and without autonomic failure, but it does not cause a greater fall in blood pressure from supine to standing at 3 min. Levodopa-induced baroreflex sympathetic noradrenergic impairment may contribute to lower blood pressure. Lower standing blood pressure with levodopa may increase the risks of fall and syncope.
- Subjects
BLOOD pressure; PARKINSON'S disease; DOPA; SYSTOLIC blood pressure; HYPOTENSION
- Publication
Clinical Autonomic Research, 2024, Vol 34, Issue 1, p117
- ISSN
0959-9851
- Publication type
Article
- DOI
10.1007/s10286-024-01024-5