Effect of levodopa on orthostatic and postprandial hypotension in elderly Parkinsonian patients.
BACKGROUND
This study describes orthostatic and postprandial hypotension in elderly Parkinsonian patients and evaluates the effect of levodopa therapy on orthostatic and postprandial hypotension in these patients.


METHODS
Seventeen elderly patients with a clinical diagnosis of Parkinson's disease or Parkinsonism based on the U.K. Parkinson's Disease Society Brain Bank criteria (age range, 66-84 years) participated in the study. Blood pressure was continuously monitored during standardized standing and meal tests, after starting 125-mg b.i.d. doses of levodopa/benserazide (Madopar) or placebo, in a double-blind, randomized, cross-over design. Seventeen age- and sex-matched healthy subjects served as controls.


RESULTS
Orthostatic hypotension was infrequently found in Parkinsonian patients (13%) and healthy subjects (6%; p =.58, between groups), whereas postprandial hypotension was more frequent in Parkinsonian patients (82%) than in healthy subjects (41%; p <.05, between groups). Doses of levodopa/benserazide, administered 2 times per day, did not result in significantly larger blood pressure decreases after standing or eating, or in higher frequencies of orthostatic or postprandial hypotension in the Parkinsonian group. Postprandial hypotension was related to disease severity (r = -.56, p <.05).


CONCLUSIONS
Postprandial hypotension, but not orthostatic hypotension, was more common in elderly Parkinsonian patients than in healthy subjects. Therapy with 125-mg b.i.d. doses of levodopa/benserazide did not significantly aggravate orthostatic or postprandial hypotension.
Mehagnoul-Schipper
D J
DJ
Department of Geriatric Medicine, University Medical Center, Nijmegen, The Netherlands.
Boerman
R H
RH
Hoefnagels
W H
WH
Jansen
R W
RW
D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001341:Autonomic Nervous System / Q000503:physiopathology; D001545:Benserazide / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D007024:Hypotension, Orthostatic / Q000188:drug therapy* / Q000503:physiopathology; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D020734:Parkinsonian Disorders / Q000150:complications* / Q000503:physiopathology; D019518:Postprandial Period / Q000502:physiology*; D011187:Posture / Q000502:physiology; D012016:Reference Values
D000978:Antiparkinson Agents; D007980:Levodopa; D001545:Benserazide