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Effect of levodopa on postural blood pressure changes in Parkinson disease: a randomized crossover study

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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.

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Data availability

The data that support the findings of this study are available from the corresponding author, GL, upon reasonable request.

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Acknowledgements

We would like to acknowledge the patients for their time and contribution.

Funding

This project was supported by a seed grant from the University of Utah. Guillaume Lamotte received honoraria for his role as managing editor of the journal Clinical Autonomic Research, Panagiotis Kassavetis received research grants from the University of Utah.

Author information

Authors and Affiliations

  1. Department of Neurology, University of Utah, Salt Lake City, UT, USA

    Timi Earl, Perla C. Thulin, Meghan Zorn, Paolo Moretti, Jumana Alshaikh, Panagiotis Kassavetis, Melissa M. Cortez & Guillaume Lamotte

  2. Utah Clinical & Translational Science Institute, University of Utah, Salt Lake City, UT, USA

    Amani Jridi

  3. Neurosciences Clinical Program, Intermountain Health, Murray, UT, USA

    Kathleen E. McKee & Kristin Mitrovich

  4. George E. Wahlen VA Medical Center, Salt Lake City, UT, USA

    Paolo Moretti & Guillaume Lamotte

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  1. Timi Earl
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Correspondence to Guillaume Lamotte.

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Earl, T., Jridi, A., Thulin, P.C. et al. Effect of levodopa on postural blood pressure changes in Parkinson disease: a randomized crossover study. Clin Auton Res 34, 117–124 (2024). https://doi.org/10.1007/s10286-024-01024-5

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  • DOI: https://doi.org/10.1007/s10286-024-01024-5

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