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Many people with Parkinson's disease suffer from low blood pressure, especially associated with postural changes. What can you do to fight this common but potentially dangerous problem?

Blood pressure issues are extremely common in Parkinson's disease patients. Over the course of your disease, you may encounter any of these problems:

  • Orthostatic hypotension (postural hypotension): As many as one in five Parkinson's patients experience low blood pressure associated with changing positions, most commonly when standing up after sitting or lying down.
  • Postprandial hypotension: Blood pressure drops after eating.
  • Nocturnal hypertension: Blood pressure spikes during the night.

Though Parkinson's disease isn't itself associated with high blood pressure, patients can of course suffer from hypertension as a separate medical issue. In this case, the combination of hypertension drugs and Parkinson's drugs may also, paradoxically, make your blood pressure dangerously low.

Orthostatic hypotension, the most common of these three problems, strikes both because of changes in the autonomic nervous system (which controls blood pressure) and because medications you're prescribed for your Parkinson's disease can induce hypotension. Hypotension, while it has many causes, happens when your blood vessels can't constrict effectively, something dehydration can play a large role in. Your blood pressure should ideally be somewhere between 100/60 and 140/90. When it drops to under 100/60, the most common symptoms are:

  • Feeling dizzy, weak, and lightheaded
  • Being fatigued
  • Confusion
  • Altered vision
  • Feeling like you may faint or actually fainting — which also means that severe hypotension places Parkinson's patients at risk of injury from falls

With postural hypotension, you'll notice these symptoms immediately after standing up. Many patients also say that they're more likely to experience the symptoms of low blood pressure in the morning, or within a few hours of taking their meds; not surprising as some Parkinson's medications will lead to lowered blood pressure.

If you've noticed these symptoms and suspect you're suffering from hypotension, talk to your doctor — leaving these problems untreated can result in injury and a poorer quality of life. You can also invest in an at-home blood pressure monitor that will allow you to keep an eye on your blood pressure yourself. 

What are some steps you and your doctor can take to normalize your blood pressure?

1. Parkinson's-related hypotension: A closer look at your medications

Levodopa and dopamine agonists, either of which will be part of nearly any Parkinson's treatment regime, are well-known to have the ability to impact your blood pressure. If your hypotension is only postural, you may not have to switch medications, but if you constantly suffer from low blood pressure, your doctor will look into changing your meds or the time at which you take them. Do remember that changing anything about your dosage or the time at which you take your Parkinson's medications on your own is a bad idea, and you should never cease taking your medication without consulting your doctor. 

2. More water and salt: Simple steps to battle low blood pressure

Increasing the amount of water you take can do wonders for your low blood pressure, especially if you were drinking too little initially. More salt in your diet is another pretty effective strategy — as you'll know, since you'll have heard that people with high blood pressure need to stay away from sodium. Though salt will get your blood pressure up, don't binge on salty foods without asking your doctor, as it can have other adverse effects, on your kidneys for instance.

3. Let coffee be your medicine

Good news for coffee lovers with hypotension — increased caffeine intake will boost your blood pressure. There is even some — inconclusive, as it was later contradicted by other studies — research to indicate that caffeine may ease the motor symptoms of Parkinson's some

4. Smaller meals, more often

Postprandial — "after meal" — hypotension is more commonly associated with larger meals. If you have experienced this, try moving away from the more traditional three larger meals a day, and instead try six smaller meals. This approach can further help fight nausea, another problem that can strike as a side effect of Parkinson's medications.

5. Stay away from hot stuff

Anyone who's suffered from low blood pressure for a while knows that its symptoms tend to get worse during hot summer weather. That is because higher temperatures relax your blood vessels, reducing your blood pressure. You'll want to stay away from hot baths and saunas, consider turning the thermostat down when relevant, and avoid exercising in hot weather. (Try an environment with airco instead, because exercise still matters.)

When it's already hot out, you're also more likely to become dehydrated — so keep drinking water!

6. Keep moving

Prolonged sitting or lying down, in the same posture, will make postural hypotension worse. Try to keep moving regularly, and don't stay in one place for hours. If you're already been sitting down for a fairly long period of time, give little movements a go before you get up — step your feet up and down, rock your torso, dance a little on your chair. 

7. Change your posture more slowly

More tips to help you change your posture more slowly include:

  • When you get up, don't immediately begin walking, but wait a while
  • Rise from a chair or bed slowly rather than suddenly
  • When you get up from bed, rise into a sitting position and maintain that for a while before you stand up
  • Bend down and reach for things slowly, if you have to do it at all

8. Can you make your bed work better?

Because lying down to sleep in a traditional flat horizontal position can reduce your blood pressure, put your bed up to a 30 degree angle if it's adjustable. If not, bed blocks may be able to help you out. 

9. Exercise your legs

While sitting or standing, do some leg exercises — marching, jiggling, and stretching all help. These kinds of exercises are often part of a physical therapy program. If you're not already attending physical therapy, ask your doctor if you can. Not only may this help your blood pressure, it can also increase your strength, flexibility and stamina while reducing stiffness; all things that are really great for Parkinson's disease patients.

10. Pharmacological options for treating hypotension

If these subtle lifestyle changes don't help sufficiently, your doctor may consider prescribing you medications that will increase your blood pressure by increasing constriction within blood vessels as well as blood volume, like:

  • Droxidopa (NortheraTM)
  • Proamatine (Midodrine)
  • Fludrocortisone (Florinef)  

As with almost any medication, it may take some experimentation before you find the drug that works well for you without causing unpleasant side effects.

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