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

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.