An Elderly Parkinsonian Patient with Extreme Blood Pressure Fluctuations

Blood pressure (BP) fluctuations after long-term levodopa therapy are rarely reported. Patients with Parkinson's disease (PD) often have dysautonomia, and neuropsychiatric and sleep disorders, which influence BP. It is difficult to control BP when hypertension coexists with these complications. We present the case of a 78-year-old man with PD who had hypotensive shock and extreme fluctuations of BP. Fluctuations in BP with the use of levodopa are more significant in patients with motor symptom fluctuations, autonomic nervous system disorders, primary hypertension, advanced stage of PD, and anxiety or sleep disorders. We controlled BP fluctuations by dividing the total daily levodopa and benserazide (Madopar) dose into smaller doses given more often, adding a sedative, and carrying out some simple nonmedical treatments for postprandial and orthostatic hypotension. At the same time, “dyskinesia” and “wearing-off” were also improved. BP fluctuations have a considerable influence on patients' quality of life and can even be life-threatening. The mechanism is complex, therefore a correct analysis of the underlying causes is needed to carry out comprehensive management. Adjustment of levodopa administration can not only stabilize BP well, but also can control PD motor complications.