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Low Blood Pressure and Parkinson's

Have you ever felt dizzy or faint when getting up from bed? How about when getting up from a chair really fast? This can sometimes be caused by a drop in your blood pressure.


What is normal blood pressure?


Normal is <120/<80 mmHg

Elevated is 120-129/<80mmHg

Stage 1 high blood pressure is 130-139/80-89mmHg

Stage 2 high blood pressure is >140/>90mmHg

Low blood pressure is <90/60mmHg



What does it mean when your blood pressure drops with certain movements?


When your blood pressure drops 20 millimeters of mercury (mmHg) in systolic blood pressure (the top number of your blood pressure reading, or a drop of 10mmHg of the diastolic blood pressure (the bottom number) within 3 minutes of standing, you may have orthostatic hypotension.


If someone without orthostatic hypotension gets up from sitting or lying down, their blood vessels constrict to send blood from their legs up to the brain. Your heart will also beat faster and stronger to help. However, due to the effect of Parkinson’s disease on the nervous system, blood vessels won’t constrict and your heart won’t pump harder when it should. This is all due to the lack of a neurotransmitter, norepinephrine. Therefore, if your blood pressure drops due to the lack of norepinephrine, it is called neurogenic orthostatic hypotension.


Someone can have neurogenic orthostatic hypotension without symptoms, but about 20% of people are symptomatic, and this will increase with age, PD duration, severity, and levodopa usage. Neurogenic orthostatic hypotension is a major concern as it can increase your risk of losing balance, falling, and fainting, all of which can lead to serious injuries.




The symptoms of nOH include the following:
  • lightheadedness

  • dizziness

  • weakness

  • difficulty thinking

  • headache

  • feeling faint

  • fainting

  • trembling

  • nausea

  • cold hands and feet

  • chest pain


Other causes of low blood pressure
  • There may be other causes for your blood pressure to drop!

  • Dehydration

  • Low blood count, or anemia

  • High blood pressure medications

  • Levodopa

  • Water pills, or diuretics

  • Some antidepressants

  • Drugs to treat urinary problems

  • Drugs for erectile dysfunction

  • Fever

  • Heart disease



How can you improve your blood pressure?


Diet changes
  • Increase your water intake. We need at least half our body weight in ounces to stay hydrated. Drinking 500ml of water will significantly increase your blood pressure for 30-90 minutes. Because of this effect, it is recommended that water is avoided in the 30-90 minutes before you go to sleep.

  • Drink a glass of cold water before you get out of bed or out of a chair.

  • Add salt to your diet, but talk with your doctor first. This is not safe for those with kidney or heart disease.

  • Eat smaller but more frequent meals throughout the day, instead of 3 large meals.

  • Avoid hot or alcoholic beverages. These can lower your blood pressure temporarily.


Lifestyle changes
  • Take your time when changing positions. Go slow and be mindful of how you feel.

  • Avoid prolonged standing, keep moving or at least shift positions.

  • Sleep with the head of the bed raised. Some people recommend 10-20 degrees, other recommend 45-50 degrees.

  • Avoid being supine during the day

  • Wear compression stockings. Knee high stockings are not effective, they need to be worn up to the abdomen. You do not need to wear stocking when sleeping.

  • Wear an abdominal binder. This can be very helpful to keep your blood pressure from dropping.

  • Exercise regularly. Check out our list of local exercise classes. For those with severe orthostatic hypotension, exercising with a physical therapist may be a good place to start.

  • Do some exercises in bed before you get up, like bridges or marching your legs.

  • Avoid excessive heat exposure. This may include hot showers for some. Try using a shower chair if you enjoy those steamy showers.

  • Avoid bearing down (valsalva maneuver) during bowel movements.



What to do if you become dizzy and you are unable to sit

  • Step in place

  • Cross your legs

  • Squeeze/clench your butt muscles and abdominal muscles

  • Clench your fists

  • Bent forward.

Neurogenic orthostatic hypotension can be really troubling. If you think you are showing some of the signs of low blood pressure, call your neurologist ASAP!


Sources:


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