POSTPRANDIAL HYPOTENSION AND PARKINSONIAN STATE IN PARKINSONS-DISEASE

Abnormal postprandial cardiovascular responses such as postprandial hy potension (PPH) occur in primary autonomic failure and contribute sign ificantly to morbidity. The extent and frequency of PPH and its relati onship to the parkinsonian state in idiopathic Parkinson's disease (IP D) is unknown. By studying 20 patients with IPD (without autonomic fai lure) and 16 age-matched controls after both groups ingested a standar d isocaloric balanced liquid meal, we have shown that supine PPH compl icates IPD and is related to marked worsening of the parkinsonian stat e as measured by a cumulative score of tremor, rigidity, bradykinesia, posture, and gait. Furthermore, significant postural hypotension is u nmasked that results in postural intolerance due to presyncopal sympto ms. Our study indicates that, in patients with IPD, ingestion of a mea l may lead to abnormal postprandial cardiovascular responses and aggra vation of the parkinsonian stage. The underlying mechanisms are unclea r, although vasodilatory gut peptides released in response to food ing estion may be contributory.