Objective: We aimed to investigate the frequency and associated risk factors for Levodopa-induced orthostatic hypotension (OH) in a large cohort of PD patients underwent acute Levodopa Challenge Test (LCT) during pre-operative evaluation.

Background: OH, is one of the most common non-motor symptoms in patients with Parkinson’s Disease (PD). Levodopa administration was reported to be an important risk factor associated with OH in PD patients. However, it is still unclear which patients are more likely to have Levodopa-induced OH.

Method: 928 out of 1353 patients with mean age of 62.37 (8.92) and average disease duration of 7.92 (5.38) years underwent an acute LCT during pre-operative evaluation were enrolled. Blood pressure (BP) in supine and 3 mins after standing were assessed before levodopa administration and then at 30-min, 1-hour, 2-hour, 3-hour, and 4-hour after. Levodopa-induced OH was defined as new onset OH during LCT in patients without OH in baseline assessment.

Results: At baseline during “off” status, 224 (24.03%) subjects fulfilled the OH definition. Levodopa-induced OH was observed in 321 (45.6%) of the remaining cases and associated with older age (OR 1.86, 95%CI 1.16~2.99, age 55-64; OR 1.78, 95%CI 1.10~2.88, age 65-74; OR 2.66, 95%CI 1.34~5.28, age≥75), probable REM sleep behavior disorder (pRBD) (OR 1.51, 95%CI 1.12~2.04), pre-existing supine hypertension (SH) (OR 1.82, 95%CI 1.35~2.46, P<0.001) and dyskinesias(OR 1.63, 95%CI 1.21~2.21).

Conclusion: The current study with a large sample of PD patients systemically demonstrate that almost half of the median stage PD patients could develop Levodopa-induced OH, particularly in those with older age, pRBD, autonomic dysfunction and dyskinesias.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-induced-orthostatic-hypotension-in-a-large-cohort-of-patients-with-parkinsons-disease-undergoing-an-acute-levodopa-challenge-test/