Symptoms - Orthostatic Hypotension

Orthostatic hypotension is a severe drop in blood pressure that happens when the person stands up from sitting or lying down. Orthostatic hypotension may cause dizziness or a loss of consciousness, causing the person to faint or pass out. It can occur within three minutes of standing up. Orthostatic hypotension can be dangerous, as it can put the person in serious risk of falls and injury.1

Orthostatic hypotension is common in elderly people, and it occurs frequently in people with Parkinson’s disease (PD). Orthostatic hypotension may affect as many as 20-30% of people with PD and seems to increase with age as well as the longer a person has PD.1,2

Orthostatic hypotension can be caused by the disease process of PD as well as a side effect of dopaminergic treatment. PD is a chronic, progressive disease that damages the nerves, including those that are responsible for maintaining blood pressure. In addition, dopaminergic drugs that are used to treat PD may cause or worsen orthostatic hypotension.2

Symptoms of orthostatic hypotension

Symptoms of orthostatic hypotension include lightheadedness, weakness, dizziness, difficulty thinking, feeling faint, and headache. Orthostatic hypotension is generally evaluated by measuring the blood pressure of a patient while sitting, or lying down, and again while standing. Currently, a person whose blood pressure drops more than 20 mm Hg in systolic pressure (the top number) or more than 10 mm Hg in diastolic pressure (the bottom number) is considered to have orthostatic hypotension. A new research study suggests a more accurate way to diagnose orthostatic hypotension is using a calculation called “upright mean arterial blood pressure,” which takes into account both the systolic and diastolic blood pressures. When this number is under 75 mm Hg, it indicates orthostatic hypotension.1

Managing orthostatic hypotension in Parkinson’s 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 (should be discussed with a doctor and avoided for anyone with heart disease)
  • Eating small, frequent meals
  • Avoiding hot drinks and hot foods1

Things that may worsen orthostatic hypotension, include:

  • Fevers
  • 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™ (droxidopa), ProAmatine® (midodrine hydrochloride), Forinef® (fludrocortisones) or Mestinon® (pyridostigmine). 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

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Written by: Emily Downward | Last reviewed: March 2017