{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:08:04Z","timestamp":1792462084838,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Levodopa (LD) is the main treatment for parkinsonism, but its use may be limited by a potential hypotensive effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated the cardiovascular effect of LD performing head\u2010up tilt test (HUTT) before and 60\u2009min after 100\/25\u2009mg LD\/dopa\u2010decarboxylase inhibitor (pre\u2010LD vs. post\u2010LD HUTT) in 164 patients with parkinsonism on chronic LD treatment. Features predictive of LD\u2010induced orthostatic hypotension (OH) were assessed by logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Basal supine blood pressure (BP) and heart rate (HR) decreased after LD. During post\u2010LD HUTT, BP drop and HR increase were significantly greater than at pre\u2010LD HUTT. Thirty\u2010eight percent of patients had OH at post\u2010LD HUTT compared to 22% of patients presenting OH at pre\u2010LD HUTT (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Risk factors for LD\u2010induced\/worsened OH were pre\u2010LD OH (odds ratio [OR] =\u200936, 95% confidence interval [CI] =\u200910\u2013131), absence of overshoot at Valsalva maneuver (OR\u2009=\u20099, 95% CI\u2009=\u20094\u201320), and pathological Valsalva ratio (OR\u2009=\u20096, 95% CI\u2009=\u20092\u201315).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LD administration caused\/worsened hypotension in both supine and orthostatic conditions. Patients with cardiovascular autonomic failure had a higher risk of developing LD\u2010induced OH. In clinical practice, LD\u2010induced OH could represent a red flag for cardiovascular autonomic failure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16061","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T14:12:17Z","timestamp":1695132737000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Levodopa\u2010induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure"],"prefix":"10.1111","volume":"31","author":[{"given":"Ilaria","family":"Cani","sequence":"first","affiliation":[{"name":"Department of Biomedical and NeuroMotor Sciences Alma Mater Studiorum \u2010 University of Bologna  Bologna Italy"},{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Guaraldi","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di 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