Orthostatic Hypotension

Orthostatic hypotension is a condition where the blood pressure drops when you stand or sometimes even sit up. This can cause dizziness, light-headedness, and fainting. It is usually harmless, but it can be a sign of a more serious problem. Also, it can be dangerous because it can lead to fainting, falls, and injury.1,2

About 1 in 3 people with PD have this form of low blood pressure.3

Symptoms

People with orthostatic hypotension may have a variety of symptoms when they stand up, including:1,2

  • Light-headedness
  • Dizziness
  • Weakness
  • Fatigue
  • Nausea
  • Blurred vision
  • Headache

How low is too low?

Sudden drops in blood pressure are dangerous. Blood pressure is a reading of 2 numbers:2

  • Systolic pressure is the top number. This is the pressure inside your arteries when your heart pumps.
  • Diastolic pressure is the bottom number. This is the pressure in the vessels while your heart is resting in between beats.

While high blood pressure is dangerous, sudden low blood pressure is as well. A sudden drop of 20 mmHg in systolic pressure is enough to cause dizziness and low blood pressure symptoms. If blood pressure remains low, the body can go into shock.2

How does PD cause orthostatic hypotension?

When you stand, gravity causes your blood to pool in your legs. Your body normally reacts by increasing heart rate and squeezing (constricting) blood vessels, making sure that enough blood reaches your brain. But for people with orthostatic hypotension, the body does not react like this, and less blood is pumped to the brain.2

The autonomic nervous system is responsible for automatic bodily functions like blood pressure. It helps make sure the body reacts to low blood pressure by increasing heart rate and squeezing blood vessels. Damage in the brain and nerves from PD can affect the function of the autonomic nervous system.4

Drugs that treat PD can cause low blood pressure as well. For example, Mirapex® (pramipexole) and those containing levodopa can impact blood pressure. Many other types of drugs can lead to orthostatic hypotension, including:2

  • Water pills
  • High blood pressure pills
  • Some anti-depressants
  • Drugs for erectile dysfunction

Underlying heart problems, dehydration, increased age, and other factors can also lead to low blood pressure. If you are having episodes of low-blood pressure, it is important for you and your doctor to first ensure your medicines or other medical conditions are not contributing.2

Treatment

Parkinson’s disease is a chronic, progressive disease with no cure at this time. However, treatment is available to help manage symptoms related to the disease. For those with low blood pressure, other treatment might be needed.1

Tips to help reduce low blood pressure episodes include:1,2

  • Drink water and increase the amount you drink
  • Minimize or avoid drinking alcohol
  • Get up slowly and stay still if feeling dizzy or lightheaded
  • Avoid sitting or laying flat for long periods
  • Avoid things that can cause you to overheat, like hot baths, saunas, or being outside for too long on a hot day
  • Raise the head of your bed slightly
  • Try to eat smaller, more frequent meals
  • Consider wearing compression stockings that reach all the way up to your hip or over your belly to avoid cutting off circulation to your legs

You and your doctor can develop a game plan to address your low blood pressure. The big thing to think about is the risk of falls. You want to maintain blood pressure that will prevent dizziness and falling.1-3

Dietary changes, such as increasing salt intake, might also help. However, many people cannot and should not do this because of underlying heart conditions. Partnering with your doctor will help you come up with the best plan to manage low blood pressure that can occur with PD.1-3

By providing your email address, you are agreeing to our privacy policy. We never sell or share your email address.

Written by: Katie Murphy │Last reviewed: April 2022