A case of Parkinson’s disease with frequent hypertensive crises following low-dose selegiline hydrochloride administration

Abstract

The patient was a 68-year-old woman diagnosed with Parkinson’s disease. Five years after disease onset, at the age of 65, her lower limb motor akinesia worsened, prompting an increase in her selegiline hydrochloride dosage from 2.5 mg/day to 5 mg/day. Following this adjustment, she began to experience hypertensive episodes lasting approximately two hours during the day, accompanied by facial flushing, fatigue, and chest pain. As these episodes became more frequent, we performed 24-hour blood pressure monitoring and measured plasma noradrenaline (NA) levels during the episodes. Hypertensive crisis and high plasma NA levels were observed mainly during the daytime, especially post-lunch. When selegiline hydrochloride was discontinued and replaced by safinamide, the hypertensive episodes ceased. Although hypertension induced by low-dose selegiline hydrochloride is rare, it is important to remain vigilant in daily clinical practice.