Response of systolic and diastolic blood pressure (mm Hg), heart rate (beats per minute), and plasma catecholamines (pg/ml) (mean (SEM)) to head up tilting at 45° for two and 10 minutes
| Group I: levodopa only (n=9) | Group II: selegiline and levodopa (n=16) | Group II: selegiline ceased (n=16) | |
|---|---|---|---|
| Supine systolic BP | 143.3 (7.7) | 141.6 (4.5) | 134.6 (3.4) |
| Tilted systolic BP at 2 min | 143.2 (10.6) (range 103 to 181) | 123.3 (5.7)a,d(range 73 to 136) | 127.2 (6.7) (range 79 to 183) |
| % Change systolic BP at 2 min | −0.4 (4.0) (range −13 to 28) | −12.0 (3.1)b (range −42 to 0) | −5.5 (4.5)e (range −33.1 to 39.7) |
| Tilted systolic BP at 10 min | 138.7 (10.6) (range 99 to 184) | 116.3 (9.2)a,d(range 0 to 175) | 128.0 (4.4) (range 92 to 164) |
| % Change systolic BP at 10 min | −3.9 (4.0) (range −21 to 20) | −18.8 (5.9)a (range −100 to 22) | −4.6 (3.0)e (range −23.1 to 23.3) |
| Supine diastolic BP | 87 (5.4) | 82.9 (3.1) | 77.6 (2.0) |
| Tilted diastolic BP at 2 min | 84.1 (5.6) (range 64 to 115) | 77.8 (3.6) (range 52 to 103) | 72.1 (2.6) (range 56 to 93) |
| % Change diastolic BP at 2 min | −3.4 (1.8) (range −14 to 5) | −5.9 (3.6) (range −30 to 29) | −6.9 (2.9) (range −33.3 to 10.7) |
| Tilted diastolic BP at 10 min | 86.6 (5.9) (57 to 115) | 67.8 (8.1) (range 0 to 127) | 77.3 (2.4) (range 58 to 97) |
| % Change diastolic BP at 10 min | −1.0 (2.8) (range −16 to 11) | −14.5 (9.6) (range −100 to 44) | −0.3 (1.8) (range −12.1 to 11.5) |
| Supine HR | 75.3 (3.6) | 79 (2.5) | 72.2 (1.9)e |
| Tilted HR at 2 min | 88.9 (5.4) (range 59–100) | 87.3 (4.8) (range 65 to 129) | 74.8 (2.0)e (range 65 to 93) |
| % Change HR at 2 min | 12.9 (6.3) (range −3 to 11) | 11.0 (5.6) (range −2 to 19) | 3.6 (1.4) (range −2.7 to 20) |
| Tilted HR at 10 min | 76.9 (4.4) (range 54 to 96) | 81.5 (3.8) (range 61 to 113) | 75.8 (1.8) (range 63 to 92) |
| % Change HR at 10 min | 2.1 (2.3) (range −10 to 13) | 2.2 (2.3) (range −16 to 8) | 5.2 (1.5) (range −3.1 to 16.7) |
| Lying noradrenaline (NA) | 297.4 (35.0) | 546.0 (209.4) | 345.4 (58.1) |
| Tilted NA at 10 min | 402.3 (55.4) | 514.9 (106.9) | 413.5 (62.1) |
| Lying adrenaline | 45.1 (17.0) | 116.6 (72.1) | 97.0 (39.6) |
| Tilted adrenaline at 10 min | 71.7 (23.3) | 118.5 (52.7) | 91.1 (19.8) |
As absolute and percentage changes were similar, only the percentage changes are shown. Selegiline therapy was associated with systolic hypotension after two and more markedly at 10 minutes of head up tilting. Withdrawal of selegiline resulted in resolution of hypotension induced by tilting. Diastolic blood pressure and heart rate were unaffected. Selegiline therapy was also associated with failure of the normal rise in plasma catecholamines. Comparison between group I and group II: aP<0.05;bP<0.01, two tailed t test. Effects of tilting within groups:dP<0.01, one way ANOVA. Comparison between group II patients before and after drug withdrawal: eP<0.05, paired t test.