Managing Orthostatic Hypotension In Parkinsons Disease
Sometimes, orthostatic hypotension can be avoided with lifestyle approaches, including:
- Drinking lots of water and other fluids to stay hydrated, especially during warm weather months
- Avoiding abrupt changes in position
- Shifting slowly from lying to sitting and then standing
- Avoiding prolonged standing
- Limiting or reducing alcohol intake
- Increasing salt intake
- Eating small, frequent meals
- Avoiding hot drinks and hot foods1
Things that may worsen orthostatic hypotension, include:
- Straining when going to the bathroom
- Vigorous exercise
- Meals high in carbohydrates1
People with PD who have orthostatic hypotension may need changes in their medications, if their doctor determines their medications may be contributing to their symptoms. Physicians, specifically movement disorders specialists, are trained to know the best treatments for hypotension for PD patients and whether treatments for PD symptoms are causing hypotension. Other medications that may help manage orthostatic hypotension include Northera , ProAmatine® , Forinef® or Mestinon® . One potential side effect of these medications that raise low blood pressure when a person is standing is that they may cause high blood pressure when the person is lying down.1
Blood Pressure And Parkinsons: Whats The Connection
This 60-minute audio with slides is an interview of two neurologists and a person with Parkinsons discussing the symptoms, causes, and how to mitigate episodes of low blood pressure, as well as high blood pressure and recent Phase III trial testing of the high blood pressure medication, isradipine, to slow Parkinsons disease progression without lowering blood pressure too much.
Hypertension And Risk Of Subsequent Motor Pd
Seven cohort studies published between 2007 and 2015 included 3,170 persons who met the criteria for PD diagnosis and 339,517 participants who had not met the criteria for PD diagnosis during follow-up. Among them, four studies reported that hypertension is associated with an increased risk of PD , whereas the other three studies indicated that there was no significant association .
Figure 2. Meta-analysis of the association between hypertension and Parkinsons disease risk.
Figure 3. Meta-analysis of the association between hypertension and Parkinsons disease risk after adjustment for the potential confounding vascular factors.
Blood Pressure Linked With Fall Risk In Patients With Parkinson Disease
People with Parkinson disease were found to be more likely than those without the condition to have orthostatic hypotension, a sudden drop in blood pressure upon standing that can exacerbate the risk of falling.
People with Parkinson disease were found to be more likely than those without the condition to have orthostatic hypotension, a sudden drop in blood pressure upon standing, according to study findings published today in Neurology.
The drop in BP that characterizes orthostatic hypotension can lead to dizziness and lightheadedness, as well as falls and fainting, notes study author Alessandra Fanciulli, MD, PhD, of the Medical University of Innsbruck in Austria, in the accompanying press release.
Among elderly adults, falls are common, affecting 19% to 49% of the general population. Moreover, falls can prove dangerous for older populations, with patients with PD at an even greater risk due to both motor and nonmotor symptoms.
“If we can monitor people’s blood pressure to detect this condition, we could potentially control these blood pressure drops and prevent some of the falls that can be so damaging for people with PD,” said Fanciulli.
They also reviewed the medical records of PwP for the 6 months preceding and following autonomic testing for history of falls, syncope, and orthostatic intolerance.
Additionally, 40% of PwP were shown to have a history of falls based on medical records, with 29% of falls caused by fainting.
What Happens In Low Blood Pressure
Low blood pressure or hypotension occurs when the blood vessels become wider and unable to constrict. This result in insufficient blood supply to all the organs of the body.
In Parkinsons, the patient experienced low blood pressure when changing position. For example, from lying to sitting or from sitting to standing. This is known as postural hypotension. When it happens, the patient starts to feel dizziness, blurred vision, fainting, and an unsteady feeling. In this situation, walking can be troublesome the patient can easily fall, which could lead to serious injuries.
Low blood pressure can also affect memory and thinking functions of the brain . Parkinsons patient experience the difficulty in moment judgment meaning they are confused where to move the leg or hand. Sometimes, these brain changes appear without feeling dizziness or blurred vision. The only way to be sure that these signs are the consequence of low blood pressure is to measure your blood pressure regularly.
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Hypertension And Diagnosis Of Parkinsons Disease: A Meta
- 1School of Public Health, Dalian Medical University, Dalian, China
- 2Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Ningxia, China
- 3Laboratory of Neurobiology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States
- 4Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
Background: Hypertension has been associated with cognitive dysfunction in the general population and patients with Alzheimers disease . However, there are contradictory data regarding the potential association between hypertension and diagnosis of Parkinsons disease , the second most common neurodegenerative disorder after AD. The purpose of this meta-analysis is to synthesize data from cohort studies to explore the potential association between preexisting hypertension and subsequent PD diagnosis.
The findings of this meta-analysis suggest that hypertension may be a risk factor for motor stage PD, which may provide novel insights into the etiology and pathogenesis of this neurodegenerative disorder. However, large-scale well-designed studies that consider various confounders are still needed to further verify and clarify the association between hypertension and PD diagnosis.
Changes Of Blood Pressure After Eating
Blood pressure is the pressure that the arterial walls experience as blood pumps through them. The blood pressure varies throughout the day and is affected by other factors as well. Blood pressure after eating, for example, can change. Usually, our body has sophisticated mechanisms to bring the blood pressure back within normal ranges.
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Common Complications And Side
As Parkinsons disease progresses , symptoms have a knock-on effect. Deterioration and impairments in the body can lead to a variety of other health concerns that cause a person great difficulty.
As much as these potential concerns cause discomfort for a person, all are treatable with appropriate medication or therapies.
Associated complications which can arise include:
How to manage some of the more common side-effects of Parkinsons disease
The nature of Parkinsons disease progression means that the condition manifests in a variety of ways, not just in areas of mobility. Non-motor symptoms can sometimes be of more distress to a sufferer, troubling their day-to-day lives even more so than their physical ailments.
Once certain non-motor symptoms are recognised, it is easier to understand why and how they are adversely affecting quality of life, as well as gain control through appropriate treatment.
Other problems which can also be effectively managed include:
How To Avoid Neurogenic Orthostatic Hypotension
If you can recognize your symptoms and are aware of what makes them worse, you can take steps to reduce and avoid them. Most importantly, avoid being dehydrated, especially during the months of hot weather. Ask your doctor to identify the medications you are taking that may lower your blood pressure and see if a change in dose is indicated. Avoid abrupt changes in position.
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Effects Of Parkinsons Disease On Blood Pressure
This short web page explains the physical operation of blood pressure in the body, symptoms of low blood pressure and when they are most likely to occur, why low blood pressure is dangerous, medical treatments and lifestyle strategies to cope with low blood pressure, and a reminder that low blood pressure can affect the ability to drive safely.
The Heart Of The Matter: Cardiovascular Effects Of Parkinsons Disease
It has long been understood that Parkinsons disease does not just cause movement symptoms, but also causes a litany of non-motor symptoms with effects throughout the body. One of the organ systems that is affected is the cardiac system, encompassing the heart, as well as the major and minor blood vessels. I received this topic as a suggestion from a blog reader and we will be discussing this important issue today. Please feel free to suggest your own blog topic.
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Other Factors That Can Affect Your Blood Pressure
Now you know that blood pressure after eating may increase or decrease. It is also important to know other factors that can also affect blood pressure readings. These include:
1. Small Blood Pressure Cuff
You have to make sure that when your blood pressure is measured, the size of cuff fits your arm circumference. If you use a cuff that is too small, it can lead to an error blood pressure reading which will increase 10-40 mm Hg for the systolic result.
2. Cuff Placed over Clothing
It is very important that the cuff of the blood pressure machine is placed directly on the arm and not over clothes. Putting the cuff over clothes can cause the blood pressure readings to increase 10-50 mm Hg.
3. Inadequate Rest Before Measurement
To measure blood pressure accurately, the patient must sit in a comfortable chair for around five minutes before measurement. The atmosphere should be calm and peaceful, and no physical activity should be carried out prior to the measurements.
4. Improper Position
The feet, arms, and the back should be properly positioned while taking the blood pressure measurements. It is estimated that an unsupported back can increase the diastolic measurements by 6 mm Hg, while crossing of the legs will also result in a similar increase. What’s more, putting your arms below your heart level will cause a lower reading result.
5. Heightened Emotions
10. Urge to Urinate
Blood Pressure Changes Can Cause Anxiety
It’s also possible for blood pressure to cause anxiety. Both low blood pressure and high blood pressure can cause changes in your heartbeat, dizziness and lightheadedness, and more. These symptoms can themselves create anxiety or trigger panic attacks, and that in turn may increase your anxiety. However, not everyone who suffers from high blood pressure experiences anxiety.
Is it Dangerous When Anxiety Affects Blood Pressure?
The greatest concern is whether or not your blood pressure changes are dangerous. The answer is a bit complicated. On the most basic level, affected blood pressure is not dangerous. Remember, random fluctuations happen all the time with no ill effects. Blood pressure is a symptom of an issue whether it’s anxiety or heart disease and not a cause of heart problems.
Your heart rate and your blood pressure also may get a break with anxiety. The body is remarkable and adjusts to chronic conditions. Some people that experience anxiety for hours on end actually find that their blood pressure adjusts to that anxiety, which ultimately means that it goes back to a base level. High blood pressure changes tend to be fairly short term, and are most common in the early stages of anxiety or during panic attacks.
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Blood Pressure Drug Shows No Benefit In Parkinson’s Disease
- American Academy of Neurology
- A study of a blood pressure drug does not show any benefit for people with Parkinson’s disease.
A study of a blood pressure drug does not show any benefit for people with Parkinson’s disease, according to findings released today that will be presented at the American Academy of Neurology’s 71st Annual Meeting in Philadelphia, May 4 to 10, 2019.
The drug isradipine had shown promise in small, early studies and hopes were high that this could be the first drug to slow the progression of the disease.
“Unfortunately, the people who were taking isradipine did not have any difference in their Parkinson’s symptoms over the three years of the study compared to the people who took a placebo,” said study author Tanya Simuni, MD, of Northwestern University Feinberg School of Medicine in Chicago and a member of the American Academy of Neurology.
The phase 3 study involved 336 people with early Parkinson’s disease at 54 sites in the US and Canada as part of the Parkinson Study Group. Half of the participants received 10 milligrams daily of isradipine for three years, while the other half received a placebo.
The drug had shown promise in animal studies, and a phase 2 study in humans did not show any safety concerns. Researchers became interested in the drug when the observation was made that use of the drug for high blood pressure was associated with a lower risk of developing Parkinson’s disease.
Tips: Avoiding Neurogenic Orthostatic Hypotension
- Drink lots of water and other fluids, at least one cup with meals and two more at other times of the day.
- Regularly practice gentle exercise and avoid long periods of inactivity.
- Eat small, frequent meals. Reduce alcohol intake and avoid hot drinks and hot foods.
- After consulting your doctor, increase your salt intake by eating prepared soups or pretzels. Note: for people with heart disease, this should be avoided.
- If you expect to be standing for a long period of time, quickly drinking two eight-ounce glasses of cold water will increase blood volume and causes blood pressure to go up for several hours.
- Try wearing compression garments such as anti-gravity stockings.
- Do isometric exercises, like marching your legs slowly in place, before getting up.
- Shift slowly from lying to sitting and then standing.
Printing made possible with a grant from Theravance. Content created independently by the Parkinsons Foundation.
For more insights on this topic, listen to our podcast episode Understanding Neurogenic Orthostatic Hypotension.
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Parkinson’s And Low Blood Pressure
Blood pressure is a measure of the force your heart exerts to pump blood around your body.
Parkinson’s and low blood pressure are often experienced together. Low blood pressure may be a late non-motor symptom of Parkinson’s disease or it can be a side effect of the medications used to treat the condition. It may also be related to a separate health condition.
Orthostatic Hypotension In Patients With Parkinsons Disease And Atypical Parkinsonism
This article outlines a study which reviewed current evidences on epidemiology, diagnosis, treatment, and prognosis of orthostatic hypotension in patients with idiopathic Parkinsons disease and atypical parkinsonism. Conclusions include recommendation for further study of OH and routine screening for timely diagnosis and further assessments beyond the recommended 3 minute postural challenge currently used.
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Papers Of Particular Interest Published Recently Have Been Highlighted As: Of Importance Of Major Importance
Balash Y, Korczyn AD, Knaani J, Migirov AA, Gurevich T. Quality-of-life perception by Parkinsons disease patients and caregivers. Acta Neurol Scand. 2017 136:1514. .
Williams-Gray CH, Worth PF. Parkinsons disease. Medicine. 2016. .
Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015-2016. NCHS Data Brief. 2017 289:18.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines . Hypertension. 2018 71:e13e115. .
Elbaz A, Carcaillon L, Kab S, Moisan F. Epidemiology of Parkinsons disease. Rev Neurol . 2016 172:1426. .
Duncan GW, Khoo TK, Yarnall AJ, O’Brien JT, Coleman SY, Brooks DJ, et al. Health-related quality of life in early Parkinsons disease: the impact of nonmotor symptoms. Mov Disord. 2014 29:195202. .
Parkinson J. An essay on the shaking palsy. 1817. J Neuropsychiatr Clin Neurosci. 2002 14:22336 discussion 222.
Managing Blood Pressure In Parkinsons Webinar Notes
In early June, the Parkinsons Foundation offered a webinar on managing blood pressure in Parkinsons disease , featuring neurologist Albert Hung. He discussed how PD impacts blood pressure regulation, how to diagnose BP issues, and approaches to treating BP in those with PD. Many in the atypical parkinsonism community especially those with multiple system atrophy and Lewy body dementia experience these BP regulation issues, so we are sharing information about the webinar here.
In particular, one issue in PD, MSA, and LBD is orthostatic hypotension , which is a drop in blood pressure when someone stands upright. To be defined as OH, the drop in BP associated with standing must be:
- Systolic BP drops at least 20 mmHg or more
- Diastolic BP drops at least 10 mmHg or more
Systolic is the upper number, and diastolic is the lower number. So a person whose BP is generally 130/70 would be experiencing OH if the person has a drop in BP to 110/60 with standing.As the speaker says:
This webinar was recorded and can be viewed here:
Lauren Stroshane with Stanford Parkinsons Community Outreach viewed the webinar and shared her notes.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Managing blood pressure Webinar notesPresented by the Parkinsons Foundation, Northeast ChapterJune 4, 2020Summary by Lauren Stroshane, Stanford Parkinsons Community Outreach
He started with a discussion of the factors that regulate BP:
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Literature Search And Selection
A search of the literature up to 13 July 2018 was performed from the databases of PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, Wan fang, VIP and CBM , using the following search terms: and . The language was restricted to English and Chinese. Moreover, we also reviewed the references of the included studies to identify additional studies which were not captured by our database searches.
Two investigators reviewed all identified studies independently, and studies were included in this meta-analysis if they met the following criteria: analytical studies the exposure of interest was hypertension the outcome of interest was PD multivariate-adjusted hazard ratio or risk ratio or odds ratio with 95% confidence interval were provided the most recent and complete article was chosen if a study had been published more than once.