Objective: To evaluate the prevalence of orthostatic hypotension (OH) after a low subacute levodopa (LD) dose in patients with diagnosis of Parkinson’s disease (PD) or other Parkinsonian syndromes (PS) under chronic LD therapy.

Background: OH is a non-motor feature of both PD and PS and may be induced or worsened by LD treatment, but the extent of this effect is still undetermined.

Methods: We consecutively recruited 97 patients (59 males; 56 PD and 41 PS; mean±SD age = 65.9±10.4 years; disease duration = 5.3±4.1 years; LD equivalent dose per day = 404.4±249.1 mg). All patients underwent cardiovascular reflex tests (head-up tilt test, HUTT, 10 min at 65°; Valsalva manoeuvre, VM; handgrip; deep breathing). HUTT was performed before (pre-LD) and 60 min after receiving a first morning fasting dose of LD/benserazide (100/25 mg). A sub-group of 18 patients was reassessed by means of HUTT twice in the subsequent morning at 60 min interval without LD administration to evaluate the effect of repeated HUTT (r-HUTT) on blood pressure (BP) response. Beat to beat systolic BP (SBP), diastolic BP (DBP) and heart rate (HR) were continuously recorded. We evaluated: 1) presence of OH, defined as a sustained reduction of SBP of at least 20 mmHg or DBP of at least 10 mm Hg within 3 min of HUTT; 2) OH related symptoms; 3) pathological VM as a sign of cardiovascular autonomic failure.

Results: 33 out of 97 patients showed pathological VM with (15 patients) or without OH (18 patients) at the pre-LD HUTT (group 1) while the remaining 64 patients showed normal VM and physiological BP response to HUTT (group 2). During post-LD assessment 10 patients of the group 1 (30%) developed OH or showed worsened OH, which became symptomatic in 5 patients. Five patients (8%) of the group 2 developed asymptomatic OH at post-LD test. Five of the 18 patients performing r-HUTT showed pathological VM with (3 patients) or without OH (2 patients) at the first HUTT. One of these 5 patients showed worsened OH at the second HUTT. None of the remaining 15 patients with normal VM and BP response at first HUTT develop OH at second HUTT.

Conclusions: Our study suggests that in a sample of patients with parkinsonism OH may be induced or worsened by LD treatment in 30% of those with cardiovascular autonomic failure and in 8% of those without.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-of-orthostatic-hypotension-after-a-low-subacute-levodopa-dose-in-patients-with-parkinsonism/