Blood pressure is a measure of the force your heart exerts to pump blood around your body. Show
Parkinson's and low blood pressure (also called hypotension) are often experienced together. Low blood pressure may be a late non-motor symptom of Parkinson's disease or it can be a side effect of the medications used to treat the condition. It may also be related to a separate health condition. Image by ©JonnyAcheson2019 How is blood pressure controlled?Blood pressure is changing – up and down – naturally during the day. It is higher if you are stressed or doing physical activity and lower when you are resting. There are sensors in the main artery in the neck (the so-called carotid system) that report your blood pressure to the brain. This is part of the autonomic nervous system (ANS), which includes the brain, nerves and spinal cord. The ANS controls a number of automatic or autonomic functions (functions your body does without you thinking about them), including the heart rate and blood pressure. As there is only a certain amount of blood in our body, the supply has to be managed so our brain monitors the blood pressure and sends messages to our heart and blood vessels to adjust it as needed. During certain activities, some parts of the body need more blood than others. For example, during exercise your blood pressure increases so that your muscles can get more oxygen. Or, if you have eaten recently, more blood goes to your stomach to allow it to digest food, reducing blood pressure elsewhere (this can make you feel sleepy). Your body also senses when you stand up and stops blood pooling in your legs (due to gravity). It does this by increasing your heart rate and squeezing or contracting your blood vessels, to move blood around your body. If blood does pool in your veins when you stand, less blood returns to the heart and as a result, less blood reaches the brain. This can cause dizziness or fainting. This is called postural hypotension and can be a problem for people with Parkinson’s. How is blood pressure measured?Blood pressure is measured by listening to your pulse in your arm, using a stethoscope with an inflated arm cuff. Two readings are taken from each beat. The first reading is a measure of the highest pressure when your heart pumps blood around your body (systolic pressure). The second is a measure of the lowest pressure when your heart is resting between beats (diastolic pressure). By taking the two readings, you are getting a maximum and minimum blood pressure. The readings are given as two numbers, both measures of pressure called ‘mm Hg’. For example, if your systolic pressure is 120mm Hg and your diastolic pressure is 70mm Hg, your blood pressure is written as 120/70. Blood pressure will vary throughout the day and from person to person but a normal blood pressure reading is generally considered to be between 90/60 and 140/90. Any readings outside of this range are classed as low or high. Low blood pressure (hypotension) causes symptoms such as light-headedness, dizziness, loss of balance or fainting. If this happens when someone stands up after lying down, then it is called othostatic or postural hypotension. Generally low blood pressure is recognised as being below 90/60. However, what may be low for one person may not be low for another. The important thing is whether symptoms such as dizziness arise at a particular level of blood pressure. Symptoms vary from person-to-person but commonly include:
These symptoms are most likely to occur when there are more demands on the body's circulation during periods of activity, for example:
Low blood pressure is not generally dangerous, unless it causes you to faint or black out which can lead to a fall or other injuries, but it can be unpleasant and may cause mild transient confusion. It can also affect your ability to drive safely and you may need to inform your car insurance company. Always talk with your doctor if you drive and have low blood pressure. Low blood pressure is also more likely if you are older, have diabetes, have medically-treated high blood pressure, or in men with prostate problems who take medication to make it easier to pass urine. You should always tell your doctor about any medications you are taking, even if they are not related to your Parkinson’s, as these may be contributory factors to lowering blood pressure. In some cases, your doctor may reconsider the use of antihypertensive drugs. Parkinson's and low blood pressureLow blood pressure is sometimes caused by Parkinson’s itself. This is because Parkinson’s affects the autonomic nervous system – the system that regulates blood pressure. The medicines used to treat Parkinson’s can also lower blood pressure. The most common blood pressure problem in Parkinson’s is orthostatic or postural hypotension which happens when you stand up after lying down. If you stand up after a period of lying down, blood tends to collect in the legs and abdomen and so the heart has to work hard to quickly pump blood to the brain. At the same time the tone of small arteries and capillaries increases. Both of these mechanisms help to control blood flow and regulate blood pressure, but in Parkinson’s these adjustments can be much slower or may not happen at all and so blood pressure can fall sharply and be slow to return to normal. Maintaining adequate blood pressure can also be affected by Parkinson’s medications, particularly levodopa and dopamine agonists. In a rare type of parkinsonism called multiple system atrophy (MSA), orthostatic hypotension is a common early symptom. This is because the autonomic nervous system is more severely and more often affected than in Parkinson’s. It is unlikely that you will experience any serious problems from postural hypotension if your Parkinson’s medication is built up gradually, your blood pressure closely monitored and you follow the suggestions given in the 'How can I help myself section?' below. Remember, it is important to take your medication as prescribed. Postural hypotension alone may not be a reason to change drugs. If you are worried about your symptoms, speak to your specialist or Parkinson’s nurse about changing your medication. But remember not to stop taking your medication, because this can be dangerous. What about high blood pressure (hypertension)?High blood pressure is much more common in the general population than low blood pressure. It can lead to serious conditions such as stroke and heart attacks, but prompt treatment can avoid such complications. Parkinson’s does not cause high blood pressure, although people may have it as an unrelated condition. It can be effectively treated, but a careful balance has to be found so that low blood pressure does not result. Treatment and managementFor many people, simply being cautious and sensible - for example getting up slowly, not changing position quickly and responding sensibly when a drop in blood pressure is more likely - is sufficient treatment. But if problems continue, talk to your doctor as they will be able to advise on strategies to help or may alter your Parkinson’s or other medications. An additional medication such as fludrocortisone may also be prescribed to increase blood volume. Your doctor will refer you to a cardiovascular specialist if necessary. Before starting any treatment, your doctor will measure your blood pressure when you are lying down and then when you are standing. Your ongoing blood pressure should be closely monitored if any of your medication is changed or a new medication added. Measuring your blood pressure across a 24-hours period may also be useful. If you faint, you should remain flat on the ground for a while afterwards so that blood can return to your brain more easily. You may temporarily be confused due to a lack of blood in the brain but this should improve as your blood pressure returns to normal. How can I help myself?There are many simple steps you can take to help cope with low blood pressure. Over time, you will learn to recognise the warning signs and triggers so that you can minimise the risk of problems occuring. You might find it helpful to keep a diary to monitor symptoms and triggers. You may find the following suggestions helpful.
Important! It is important to be aware that blood pressure can significantly drop when taking medication to lower blood pressure at the same time as some Parkinson’s medications. Discuss all medications with your doctor so that he or she can decide whether medication to lower blood pressure should be adjusted. Content last reviewed: March 2021 AcknowledgementWe would like to thank Dr Annamária Takáts (Medical Advisor, Delta Hungarian Parkinson Association, Budapest) for her help in reviewing this information. Our thanks to Parkinson’s UK for permission to use the following source:
Is low blood pressure common in Parkinsons?Many people with mid and late-stage Parkinson's experience low blood pressure, known as hypotension. This can be a symptom of Parkinson's, it can be a side effect of the medications used to treat Parkinson's, or it may be connected to another health condition. Low blood pressure does not cause major problems.
What helps low blood pressure Parkinson's?Several medications may be helpful in treating orthostatic hypotension in PD patients. These include fludrocortisone, midodrine, and droxidopa. These drugs can be used alone or in combination. Doses can be adjusted to help prevent BP from dropping to very low levels.
What is considered a dangerously low blood pressure?Generally, if the blood pressure reading is under 90/60 mm Hg, it is abnormally low and is referred to as hypotension.
What are the final stages of Parkinsons disease?When patients reach stage five – the final stage of Parkinson's disease – they will have severe posture issues in their back, neck, and hips. They will require a wheelchair and may be bedridden. In end-stage of Parkinson's disease, patients will also often experience non-motor symptoms.
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