“Everybody’s always asking me about my blood pressure. They did an interview once where they hooked me up to a blood pressure machine and they rile me. I’d yell and scream and then it would go back to normal in few minutes. Everything else probably rotting inside – but my BLOOD PRESSURE is spectacular.” Lewis Black
Today, I thought I would visit the topic which causes much distress and casualties in many people suffering from Parkinson’s disease and other Parkinsonian syndromes known as low blood pressure or orthostatic hypotension. Especially important is the fact that after more than 10years, there is finally a new drug approved in the states by the FDA for neurogenic orthostatic hypotension [OH] (abnormal low blood pressure with standing). [This is of significance because February is “Go Red“month to promote cerebrovascular and cardiovascular-heart and brain health- and having too low of a blood pressure like too high of a blood pressure can be a risk factor for stroke.] OH can be seen in many neurological diseases but is frequently present in all the Parkinson syndromes. Depending on the Parkinson type of syndrome, the low blood pressure can occur at the onset of disease or towards the middle or the end and the severity can vary accordingly.
In Parkinson’s disease, the symptoms of feeling faint, dizzy, lightheaded usually comes on mid to late stage in the disease and can be exacerbated by intake of Parkinson medication especially dopamine agonists . The symptoms can be so severe and alarming causing a person to fall, pass out, subsequently lead to repeated head traumas and other injuries and broken bones along with frequent emergency room or doctor visits. In an already frail or debilitated person this can be very devastating, lead to worsening Parkinson symptoms indirectly due to immobility or worsening cognitive problems from pain meds not to mention expensive!
Orthostatic Hypotension (OH) is define by physicians as a sharp drop in blood pressure of 20 millimeters of mercury (20mm Hg) or more in systolic pressure (top number) or 10 mm Hg in diastolic pressure (bottom number) with standing either from sitting or arising from bed or from a chair – this phenomena occurs within 3 minutes of standing.
Some of the symptoms of OH are balance loss, unsteadiness, weakness, headache, dizziness, nausea, tremors, fainting, poor concentration, lightheadedness, clammy hands and feet, chest pain.
Sometimes in order to be sure that we are dealing with orthostatic hypotension is to have your doctor measure your blood pressure…the doctor may need to check it in three different positions just to be sure…sitting, standing , and laying down and sometimes if not entirely sure they may refer you to have a tilt table test.
Risk factors include:
Age-elderly over 65
Pregnancy– uterus gets big press on large veins decreasing blood flow
Medications-taking blood pressure meds, PD meds
Central nervous system disease– I.e. Parkinson’s
Dehydration– not drinking enough water, alcohol consumption, vigorous exercise, exposure to heat, fever,
Prolonged bed rest/Changing body position/ prolonged standing
Straining while going to bathroom
Normally with a healthy autonomic system when an individual arises from sitting or standing, the blood vessels constrict to adjust to the change in pressure and increase the blood flow to the brain. If you remember your Physics, since the vessels are smaller the pressure has to be higher and travel faster to get through a smaller diameter to reach its given destination. Therefore, the heart has to increase blood flow (rate). But, Parkinson’s patients and other parkinsonian individuals [as well as others with neurogenic diseases involving abnormal peripheral nervous system ] can not make heart pump faster so blood pressure drops and because blood is not getting to brain fast enough as it is required they pass out or feel faint.
For those of you who have OH or live with someone who ha sit know the devastation and the havoc it can wreak in someone’s life ….it can leave you stranded when and unable to cope or perform even the simplest of tasks when symptoms are severe. For those that don’t have severe Oh, there are several tricks to coping with OH as well as a number of medications. However, as in life nothing is a 100% foolproof or tolerable by everyone. Therefore, I am very grateful to have one more new drug added to the armamentarium of tools to which combat this complex and even potentially life threatening problem. The new comer is droxidopa or Northera ….was just approved by FDA for treatment of neurogenic OH. This is to be taken 100mg 3x a day to a maximum of 600mg 3x a day. Potential adverse effects are an unhealthy increase in blood pressure requiring immediate medical attention, stroke; other less serious side effects include: nausea, headache, high blood pressure, dizziness, and fatigue.
Other medications that we currently in the states to treat OH are salt tablets, Florinef, midrodine (Pro amantine).
Sometimes outside indications for medicines that have side effects of increase high blood pressure might be used by some physicians as last resort.
Aside from medical therapy there are some steps that you can take to prevent falls by decreasing symptoms of OH.
1) Drink lots of fluids
2) exercise regularly
3) periodic review of medications especially blood pressure and antidepressants like tricyclics examples of these…elavil)
4) wear compression stockings…can buy at any drug store
5) get up slowly from bed or from sitting
6) avoid alcohol consumption
7) make sure salting food …talk to doctor first
8) sleep with head of bed elevated 15 degrees…put a brick at head of bed.
9)eat small frequent meals
10) take 2 (8 ounce) cups of cold water if you will be standing for a long period of time or before you get out of bed…avoid hot beverages hot food
11) wear abdominal binder before getting up but make sure you remove prior to returning to bed.
12)when you stand up aside from standing up slowly do iso Eric exercises …stand on one leg for few minutes then bend knew continue standing then switch legs and repeat if unsteady don’t try unless you can hold on to someone or something and careful not to fall or hurt yourself.
13) avoid bending at the waist-always bend with your knees
14) if while standing start to feel dizzy- cross your legs in scissor fashion & squeeze or put one foot on a chair or ledge & lean forward as far as possible.
copy right @2013
all rights reserved -by Maria De Leon MD