Abstract
Objective: Levodopa up-titration is the primary therapeutic strategy as the Parkinson’s disease (PD) progresses. However, the effects of levodopa up-titration on blood pressure (BP) are inconclusive. This study aimed to investigate the effect of acute levodopa up-titration simulated by levodopa challenge test (LCT) on BP in patients with early stage PD.Methods: We monitored BP in 52 patients with early stage PD using a standardized standing test. BP was assessed in supine position after 10 min of rest and at 1 and 3 min after standing up. BP was measured in the “off-state” and the best “on-state” during LCT in the morning at hospital. In another day, “off-state” and the best “on-state” BP was measured before and after anti-PD drug uptake in the morning at home. Demographic and clinical features of the patients were evaluated and analyzed.Results: In the LCT, the prevalence of OH in the “off-state” and the best “on-state” was 11.5 and 13.5%, respectively. Additionally, the OH in the best “on-state” was associated with OH in the “off-state” and monoamine oxidase B inhibitor use. Although 38 (73.1%) patients experienced levodopa-induced hypotension during the LCT, no risk factors were identified. While BP reductions were observed after taking anti-PD drugs at home, no further reduction was seen during acute levodopa up-titration simulated by the LCT.Conclusion: Our results demonstrate that acute levodopa up-titration does not exacerbate BP reduction induced by anti-PD drugs at home. BP monitoring is critical for the management of patients with PD.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting approximately 0.39% of the Chinese population above 50 years of age (Li et al, 2019)
The blood pressure (BP) measurements of these according to methods described in a previous study
The MDS-UPDRS part III was assessed in treatment, of whom 42 received only levodopa/benserazide, the “off-state” and the best “on-state” during LCT
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting approximately 0.39% of the Chinese population above 50 years of age (Li et al, 2019). In addition to the classic motor symptoms (i.e., bradykinesia, rigidity, and resting tremor), attention has been increasingly paid to non-motor symptoms (NMS), including olfactory dysfunction, sleep disorders, Levodopa’s Effect on Blood Pressure anxiety, depression, and autonomic dysfunction in patients with PD (Postuma et al, 2015; Schapira et al, 2017). Autonomic dysfunction is a prominent symptom of PD, cardiovascular autonomic dysfunction, which occurs in approximately 70% of patients with PD (Goldstein et al, 2000). The common cardiovascular autonomic dysfunctions associated with PD include blood pressure (BP) abnormalities, such as hypotension, orthostatic hypotension (OH), which can occur at any phase of PD (Schapira et al, 2017). Monitoring BP is a vital part of the daily management of patients with PD
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