1. The intra-arterial blood pressure responses to Valsalva's manoeuvre and postural change were investigated as indices of cardiovascular reflex activity in seventeen Parkinsonian patients on maximally tolerated doses of l(-)-dopa (levodopa) and repeated in nine patients on levodopa with an extracerebral decarboxylase inhibitor, l-alpha methyldopahydrazine. The results were compared with control pretreatment responses.
2. There was significant impairment of the pressor response to Valsalva's manoeuvre on levodopa, which returned to control values after the addition of l-alpha methyldopahydrazine.
3. The systolic, diastolic and mean arterial pressures measured in a horizontal position during treatment with levodopa, with and without l-alpha methyldopahydrazine, were significantly lower than pretreatment values.
4. It is concluded that the impairment of baroreflex function by levodopa is mediated, at least in part, at the periphery. In contrast, mechanisms operating within the central nervous system contribute to the lowering of blood pressure recorded in the horizontal position in patients receiving levodopa.