Effect of levodopa on orthostatic and postprandial hypotension in elderly parkinsonian patients

Background. This study describes orthostatic and postprandial hypotension i n elderly parkinsonian patients and evaluates the effect of levodopa therap y tin 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 Bra in Bank criteria (age range, 66-84 years) participated in the study. Blood pressure was continuously monitored during standardized standing and meal t ests, 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 pat ients ( 13%) and healthy subjects (6% p = 58, between groups), whereas post prandial hypotension was more frequent in parkinsonian patients (92%) than in healthy subjects (41%; p < .05, between groups). Doses of levodopa/bense razide, administered 2 times per day, did not result in significantly large r blood pressure decreases after standing or eating, or in higher frequenci es of orthostatic or postprandial hypotension in the parkinsonian group. Po stprandial 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. The rapy with 125-mg b.i.d. doses of levodopa/benserazide did not significantly aggravate orthostatic or postprandial hypotension.