Objective: To evaluate the effect of levodopa and orthostatism on heart rate variability (HRV) in a sample of consecutive subjects with Parkinson’s disease (PD).

Background: Recent evidence suggests that HRV can be used as a marker of autonomic impairment in Parkinson’s disease. However, there is little evidence regarding the influence of stress (such as orthostatism), dopaminergic medication and their interaction on HRV in PD.

Method: Twenty-seven patients with PD underwent a comprehensive clinical evaluation by means of clinical interview and validated clinical scales for motor and non-motor symptoms (autonomic functions and neuropsychologic symptoms).
Objective autonomic assessment included recording of blood pressure, heart rate and heart rate variability over three consecutive minutes during sustained sitting and standing position. Patients were evaluated both OFF and ON their regular dopaminergic medications.
Heart rate variability was recorded by means of an H10 polar belt and its spectral analysis was performed by trigonometric regression spectral analysis with fast Fourier transform (FFT) using Kubios software. We took into account the following parameters: the root mean square of successive differences (RMSSD), the high frequency power of R-R interval (RR-HF), and the ratio between the low and high frequency power of R-R interval (LF/HF).

Results: A two-way repeated measured analysis of variance (ANOVA) was conducted with position (sitting versus standing) and time (before and after levodopa) as factors. We found a significant effect of position for rMSSD (F=0.24, p=<0.0001) and RR-HF (F=9.3, p=0.005) but no effect of medication and no interaction medication*position.
Indeed, standing reduced RMMSD and RR-HF both in OFF and ON medication conditions.
When considering the LF/HF ratio there was a significant effect of position (F=5.4, p=0.03) and medication (F=6.6, p=0.017) but no interaction position*medication (F=2.3, p=0.1). Post-hoc analysis showed that LF/HF ratio increased when standing and when ON levodopa.

Conclusion: Heart rate variability in Parkinson’s is significantly influenced by the effect of position and levodopa. Our data suggest an effect of levodopa on the sympatho/vagal balance as measured by HRV.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/heart-rate-variability-is-affected-by-standing-and-medication-intake-in-parkinsons-disease/