Abstract Details

Title Effect of Levodopa on Blood Pressure and Baroreflex Function in Parkinson's Disease

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-003

Objective We investigated the effect of levodopa on blood pressure and baroreflex function in individuals with Parkinson disease (PD) with (PD^+OH) and without neurogenic OH (PD^-OH).

Background The association between levodopa and orthostatic hypotension (OH) remains controversial.

Design/Methods We performed a prospective randomized cross-over study with autonomic testing performed ON and OFF levodopa. The primary outcome was the change in systolic blood pressure (SBP) from supine to 70-degree-tilt at 3 minutes (ΔSBP-3’). Secondary outcomes included indices of baroreflex function and blood pressure and heart rate measured at regular intervals during tilt.

Results We enrolled 40 individuals with PD (21 PD^+OH, 19 PD^-OH, mean age (SD)=73.2 years (7.9), 13 females (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 – 0.96] (p=0.14). Mean difference in ΔSBP-3’was -2.14mmHg [-7.55 – 3,28] (p=0.45) in PD^+OH and -5.14mmHg [-11.63 – 1.35] (p=0.14) in PD^-OH. Mean difference in ΔSBP ON levodopa was greater compared to testing OFF levodopa at 7 and 10 minutes (-7.52mmHg [-11.89 – -3.15], p=0.002, and -7.82mmHg [-14.02 – -1.67], p=0.02 respectively). Levodopa was associated with lower blood pressure in the supine position and during 70-degree-tilt in both PD^+OH and PD^-OH. Levodopa was associated with cardiovascular noradrenergic baroreflex impairment.

Conclusions

Levodopa causes hypotension in both PD^+OH and PD^-OH. Levodopa may unmask
autonomic dysfunction in PD^-OH and cause delayed OH. Baroreflex sympathetic noradrenergic
impairment may contribute to levodopa-induced hypotension. Studies with larger sample size
will clarify the relationship between levodopa and classic OH.

Authors/Disclosures
Timi Earl PRESENTER	No disclosure on file
Amani Jridi	No disclosure on file
Perla C. Thulin, MD (University of Utah Department of Neurology)	Dr. Thulin has nothing to disclose.
Meghan Zorn, PA (University of Utah)	Ms. Zorn has nothing to disclose.
Kathleen McKee, MD (Intermountain Healthcare)	Dr. McKee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceraxis.
Kristin E. Mitrovich, MD	Dr. Mitrovich has nothing to disclose.
Paolo M. Moretti, MD (University of Utah)	The institution of Dr. Moretti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie, Inc. The institution of an immediate family member of Dr. Moretti has received research support from NIH. The institution of an immediate family member of Dr. Moretti has received research support from VHA. The institution of an immediate family member of Dr. Moretti has received research support from DOD.
Jumana T. Alshaikh, MD (University of Utah)	Dr. Alshaikh has nothing to disclose.
Panagiotis Kassavetis, MD (University of Utah)	Dr. Kassavetis has nothing to disclose.
Melissa M. Cortez, DO (University of Utah Neurology)	The institution of Dr. Cortez has received research support from NIH NINDS. The institution of Dr. Cortez has received research support from Dysautonomia International. Dr. Cortez has received personal compensation in the range of $500-$4,999 for serving as a Content Expert, Reviewer, DSMB with NIH RECOVER project.
Guillaume Lamotte, MD	Dr. Lamotte has nothing to disclose.

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