Effect of Acute Levodopa Up-Titration on Blood Pressure in Patients With Early Stage Parkinson's Disease: Results of a Levodopa Challenge Test

• Published in: Frontiers in aging neuroscience Vol. 13; p. 778856
• Main Authors: He, Xiaoqin, Mo, Chengjun, Zhang, Yi, Cai, Ying, Yang, Xiaodong, Qian, Yiwei, Xiao, Qin
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 03-01-2022; Frontiers Media S.A
• Subjects: Aging; Amine oxidase (flavin-containing); Antihypertensives; Anxiety; Behavior disorders; Blood pressure; Dopamine; Drug dosages; Hospitals; Hypotension; Levodopa; levodopa challenge test; Movement disorders; Neurodegenerative diseases; Neuroscience; Parkinson's disease; Patients; Quality of life; Questionnaires; Regression analysis; Risk factors; Sleep; Titration; hypotension; blood pressure; levodopa challenge test; levodopa; Parkinson’s disease
• ISSN: 1663-4365; 1663-4365
• DOI: 10.3389/fnagi.2021.778856

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.
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.
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.
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.