To investigate the features and potential risk factors of orthostatic hypotension (OH) in early-onset Parkinson’s disease (EOPD) and examine its influence on motor and non-motor function. Methods: For this study, 131 EOPD patients were enrolled. Basic patient information and a comprehensive set of clinical features including both motor and non-motor symptoms were recorded. Patient lying to standing blood pressure (BP) was measured during the acute levodopa challenge test at pre-drug and 1, 2, and 3 hours post-drug; the MDS-UPDRS Ⅲ score was recorded, and the motor response was calculated. Patients were divided based on occurrence of OH into the OH group or non-OH group. Patient demographics and clinical features were compared between the 2 groups, and the risk factors for OH were analyzed. Results: The 131 EOPD patients included 69 with OH and 62 without. The prevalence of OH was 52.7%. OH group patients showed a longer disease course, higher incidence of supine hypertension and wearing-off, better motor response to levodopa, and higher scores of postural instability and gait difficulty (all P<0.05). OH group patients exhibited higher scores in the freezing of gait questionnaire (FOGQ), Cleveland constipation score (CCS), and Parkinson’s disease questionnaire 39 (PDQ-39), and the difference was statistically significant (all P<0.05). Logistic regression analysis revealed that risk factors for OH in EOPD patients were supine hypertension (OR=11.057, P=0.000) and constipation (OR= 1.170, P=0.019). Conclusion: OH is a common manifestation of autonomic impairment in EOPD patients and is more likely to occur after levodopa use. Levodopa can decrease supine and standing systolic BP in EOPD patients. Supine hypertension and constipation are risk factors for OH in EOPD patients. We recommend assessing supine hypertension and OH in PD patients by performing lying to standing tests 1-2 hours after taking anti-Parkinsonian drugs to assist physicians in planning appropriate treatment.