Differential effects of various treatment combinations on cardiovascular dysfunction in patients with Parkinson's disease

• Published in: Acta neurologica Scandinavica Vol. 109; no. 1; pp. 45 - 51
• Main Authors: Korchounov, A., Kessler, K. R., Schipper, H. I.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01.01.2004; Blackwell
• Subjects: adverse effects; Aged; Antiparkinson Agents - adverse effects; Antiparkinson Agents - therapeutic use; autonomic nervous system; Biological and medical sciences; Cardiovascular Diseases - chemically induced; combination; drug therapy; Drug Therapy, Combination; Electrocardiography; Female; Humans; Hypotension, Orthostatic - chemically induced; Incidence; Male; Medical sciences; Middle Aged; Neurology; orthostatic hypotension; Parkinson Disease - complications; Parkinson's disease; Human; orthostatic hypotension; Nervous system diseases; Parkinson's disease; drug therapy; Parkinson disease; Cerebral disorder; Treatment; Autonomic nervous system; Central nervous system disease; adverse effects; Degenerative disease; Extrapyramidal syndrome; combination
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1034/j.1600-0404.2003.00172.x

Objectives – Patients with Parkinson's disease (PD) frequently suffer from cardiovascular dysfunction, which may be enhanced to various extents by different antiparkinsonian drugs. Materials and methods – We analysed electrocardiogram (ECG) abnormalities, cardiovascular reflexes (CVR) and orthostatic hypotension (OH) in 148 patients with idiopathic PD assigned to five different combination therapies of levodopa (LD) plus either bromocriptine (BRO), ropinirole (ROP), selegiline (SEL), anticholinergic (ACH) or amantadine (AMA) or to LD monotherapy before and after a 1‐week washout of the add‐on drug. Patients were matched for age and disease severity (Hoehn and Yahr stage 2–3). Rater‐blinded cardiovascular testing was performed at baseline, and following a 1‐week washout period of the add‐on drugs. Results – We found that the incidence of cardiovascular dysfunction was generally higher in patients receiving a combination therapy compared with patients on LD monotherapy. ECG abnormalities were found in 40–52% of patients in combination therapy, but in only 20% of the patients receiving LD monotherapy. After discontinuation of BRO and SEL, there were significant improvements in ECG, OH and CVR. After washout of ACH and AMA, a significant improvement was found only in the CVR score. AMA and ROP were the add‐on drugs with the least adverse cardiovascular effects. Conclusion – We conclude that pre‐existing cardiovascular autonomic dysfunction should be investigated and taken into account when deciding which combination therapy to choose in the treatment of parkinsonian patients.