Objective: To investigate factors that may affect blood pressure in patients with PD (Parkinson’s disease).

Background: PD affects the autonomic nervous system, potentially leading to labile blood pressure (BP). Likewise, dopaminergic medications, through unclear mechanisms, may further lower BP and contribute to the development of orthostatic hypotension (OH).

Method: Medical records of consecutive PD patients seen in the movement disorders clinic between July 2017 and Aug 2018 were reviewed for demographic information, systolic and diastolic BP (SBP and DBP) in seated and standing positions (1 minute), as well as medications for PD. OH is defined as > 20 mmHg in SBP or > 10 mmHg drop in DBP. Data were analyzed to study the effect of season (winter vs. summer), medication status (on vs. off PD medications), gender, L-dopa, dopamine agonists, and monoamine oxidase type B (MAOB) inhibitors on BP.

Results: Two hundred and thirty-five patient visits were included. Patients that were OFF PD medications on the day of the visit have higher baseline BP compared with those who were ON PD medications (n = 29 OFF, 147.7±19.2/83.8±10 vs. n = 29 ON 136.5±23.2/78.2±10.7 mmHg, p = 0.007/0.008). Interestingly, although L-dopa and dopamine agonists lower BP, patients who were OFF PD medications showed a more significant drop in SBP when standing compared with patients who were ON PD medications (14.9 vs. 9.5 mmHg, p = 0.048). In patients ON PD medications, there was a higher proportion of male patients that were positive for OH compare with female patients (33 out of 119 vs. 5 out of 49, p < 0.05). OH did not vary as a function of season (Nov-Feb vs. Jun-Sept) or patient age. OH tended to correlate with higher total daily equivalent L-dopa (690±406 vs. 598±335 mg, p = 0.18). Specifically, taking dopamine agonist or MAO-B inhibitors did not impact BP measures.

Conclusion: OH is very common in PD but remains under-recognized, as most PD patients do not specify overt OH symptoms, but rather attribute these to PD. Patients not taking their regular PD medications had increased BP, demonstrating the importance of timing when taking BP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predictors-of-orthostatic-hypotension-in-patients-with-parkinsons-disease/