Ask the MD: What Is Orthostatic Hypotension?

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Posted by  Rachel Dolhun, MD, January 22, 2015

Rachel Dolhun, MD, is a trained movement disorder specialist who works in medical communications at The Michael J. Fox Foundation. 

Orthostatic hypotension is a drop in blood pressure upon changing positions, such as moving from sitting to standing. It’s also a non-motor symptom of Parkinson’s disease. Orthostatic hypotension may cause lightheadedness and dizziness, which can result in passing out, fatigue and nausea. It could also contribute to gait instability and falls.

Low blood pressure has many possible causes beyond Parkinson’s disease. Dehydration could be the culprit, as well as many medications, including:

• high blood pressure medications,
• diuretics (fluid pills),
• antidepressants
• and many of the medications used to treat PD.

Other diseases, such as infection or anemia (low blood count), could also be to blame.

To look for orthostatic hypotension, doctors measure blood pressure while the patient is lying down, sitting and standing. Blood and/or urine tests may be performed to rule out other contributing factors.  

How Is Orthostatic Hypotension Treated?

Treatment depends on symptoms and the main reasons for low blood pressure. Your doctor may suggest dietary modifications, compression devices, adjustment strategies (described below) or medication changes.

If limited fluid intake is the problem — and you don’t have any heart or kidney problems —increased fluid and salt intake is usually recommended. Aim for five 8 ounce glasses of cold fluid – such as water, Gatorade, V8 juice — per half day. One way to ensure you drink enough is to fill a gallon container with fluid in the morning and empty from there throughout the day.

With regard to salt intake, table salt can be used liberally, and salty foods (canned soups, for example) can be added to meals. If that’s not to your taste, you might try over-the-counter salt tablets as directed by your physician. Caffeinated beverages, hot liquids and alcohol should be limited as they can lower blood pressure or worsen dehydration. Eating frequent, small meals and limiting carbohydrate intake will smooth blood pressure fluctuations, as well.

You may want to try lower extremity compression hose or abdominal binders to encourage normalization of blood pressure, but these are difficult to put on and can be uncomfortable.

• Other simple adjustments may have great benefit:
• Raise the head of the bed at night or use more pillows.
• Drink a full, cold glass of water prior to standing up.
• Change positions cautiously and slowly.
• Avoid prolonged standing, or shift positions/cross your legs if you do.
• Engage in regular physical exercise.

Another tactic your doctor may suggest is to alter your medication regimen. Initially this may be a decrease or discontinuation of high blood pressure medications or diuretics, or a switch in the formulation or dosage of Parkinson’s medications. If these are not effective or if blood pressure problems are particularly severe, your physician may prescribe a drug that elevates blood pressure. Options include midodrine, fludrocortisone, pyridostigmine and droxidopa.

NOTE: The medical information contained in this article is for general information purposes only. The Michael J. Fox Foundation has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson’s disease and any other medical condition be made in consultation with a physician or other qualified medical professional.

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