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

He, Xiaoqin; Mo, Chengjun; Zhang, Yi; Cai, Ying; Yang, Xiaodong; Qian, Yiwei; Xiao, Qin

doi:10.3389/fnagi.2021.778856

Cited by 3 publications

(7 citation statements)

References 30 publications

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diovascular autonomic failure, but secondary causes could also contribute [3,4]. Among the latter, LD administration could induce a hypotensive effect, with a decrease in blood pressure (BP) during supine position and orthostatic stress [5][6][7][8][9][10][11]. A recent review failed to show a conclusive relationship between LD and OH; however, in the selected studies OH was roughly recorded as an adverse event or derived from measurement of vital signs, without further specification [5].Peripherally, LD causes vasodilatation in the renal vascular beds and inhibits the release of catecholamines from the postganglionic sympathetic nerves, lowering sympathetic activity on vascular

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confidence: 99%

Levodopa‐induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure

Cani,

Guaraldi,

Giannini

et al. 2023

Euro J of Neurology

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Background and purposeLevodopa (LD) is the main treatment for parkinsonism, but its use may be limited by a potential hypotensive effect.MethodsWe evaluated the cardiovascular effect of LD performing head‐up tilt test (HUTT) before and 60 min after 100/25 mg LD/dopa‐decarboxylase inhibitor (pre‐LD vs. post‐LD HUTT) in 164 patients with parkinsonism on chronic LD treatment. Features predictive of LD‐induced orthostatic hypotension (OH) were assessed by logistic regression analysis.ResultsBasal supine blood pressure (BP) and heart rate (HR) decreased after LD. During post‐LD HUTT, BP drop and HR increase were significantly greater than at pre‐LD HUTT. Thirty‐eight percent of patients had OH at post‐LD HUTT compared to 22% of patients presenting OH at pre‐LD HUTT (p < 0.001). Risk factors for LD‐induced/worsened OH were pre‐LD OH (odds ratio [OR] = 36, 95% confidence interval [CI] = 10–131), absence of overshoot at Valsalva maneuver (OR = 9, 95% CI = 4–20), and pathological Valsalva ratio (OR = 6, 95% CI = 2–15).ConclusionsLD administration caused/worsened hypotension in both supine and orthostatic conditions. Patients with cardiovascular autonomic failure had a higher risk of developing LD‐induced OH. In clinical practice, LD‐induced OH could represent a red flag for cardiovascular autonomic failure.

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confidence: 99%

Levodopa‐induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure

Cani,

Guaraldi,

Giannini

et al. 2023

Euro J of Neurology

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“…[24] Another study monitored BP in patients (mean age = 65.2 years) with early stage PD using a standardized standing test and reported that 73.1% of patients experienced L-dopa induced hypotension during the LCT, and the prevalence of OH in the best “on-state” was 13.5%, while age was not associated with L-dopa related OH. [9] In the LCT, our patients with OH were all symptomatic, caomparatively older (mean age = 65.31 years), had lower MoCA scores, and took higher doses of L-dopa than patients without OH. Finally, multivariate logistic regression analysis confirmed that only age was an independent risk factor for LCT-induced OH.…”

Section: Discussionmentioning

confidence: 99%

“…Paradoxically, some other studies have reported OH attributed to increased L-dopa doses in a short time. [9,10] Hyperresponsiveness to dopaminergic drugs is an important characteristic of PD. Drug stimulation tests, such as the acute levodopa challenge test (LCT), designed to acutely stimulate central dopaminergic receptors [11] can be applied to predict sustained long-term L-dopa responsiveness.…”

Section: Introductionmentioning

confidence: 99%

“…Paradoxically, some other studies have reported OH attributed to increased L-dopa doses in a short time. [9,10]…”

Section: Introductionmentioning

confidence: 99%

“…Very few studies have investigated the relationship between LCT and OH. [9,10] Therefore, this study aimed to investigate the characteristics and influencing factors of OH induced by LCT in a relatively large sample of patients with PD. The outcomes of this study may improve our understanding of OH in PD and eventually help in its prevention or management.…”

Section: Introductionmentioning

confidence: 99%

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Age as a risk factor for orthostatic hypotension induced by the levodopa challenge test in patients with Parkinson’s disease: Results from a single-center trial

Su²,

et al. 2023

Medicine

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Background: Hypotension can occur in patients receiving levodopa (L-dopa) treatment for parkinsonism. However, only few studies have focused on the characteristics of orthostatic hypotension (OH) induced by the L-dopa challenge test (LCT). This study aimed to investigate the characteristics and influencing factors of LCT-induced OH in a relatively large sample of patients with Parkinson’s disease (PD). Methods: Seventy-eight patients with PD without a previous diagnosis of OH underwent the LCT. Blood pressure (BP) in the supine and standing positions was measured before and 2 hours after the LCT. If diagnosed with OH, the patients’ BP was monitored again 3 hours after the LCT. The clinical features and demographics of the patients were analyzed. Results: Eight patients were diagnosed with OH 2 hours after the LCT (median dose of 375 mg L-dopa/benserazide; incidence = 10.3%). One patient without symptoms had OH 3 hours after the LCT. Compared with patients without OH, patients with OH had lower 1- and 3-minutes standing systolic BP and 1-minute standing diastolic BP at baseline and 2 hours after the LCT. Patients in the OH group were of older age (65.31 ± 4.17 years vs 59.74 ± 5.55years) and had lower Montreal Cognitive Assessment scores (17.5 vs 24) and higher L-dopa/benserazide levels (375 [250, 500] mg vs 250 [125, 500] mg). Older age markedly increased the odds of having LCT-induced OH (odds ratio, 1.451; 95% confidence interval, 1.055–1.995; P = .022). Conclusions: LCT increased the odds of OH in non-OH PD, causing symptomatic OH in 10.3% of patients in our study, thereby raising safety concerns. Increase in age was observed to be a risk factor for LCT-induced OH in PD patients. A study with a larger sample size is warranted to confirm our results. Trial registration number: Clinical Trials Registry under ChiCTR2200055707. Date of registration: January 16, 2022.

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Effects of different levodopa doses on blood pressure in older patients with early and middle stages of Parkinson's disease

Zhang²,

Su³

et al. 2023

Heliyon

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

Cited by 3 publications

References 30 publications

Levodopa‐induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure

Levodopa‐induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure

Age as a risk factor for orthostatic hypotension induced by the levodopa challenge test in patients with Parkinson’s disease: Results from a single-center trial

Effects of different levodopa doses on blood pressure in older patients with early and middle stages of Parkinson's disease

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