Orthostatic Hypotension in Patients With Parkinson's Disease
Orthostatic Hypotension in Patients With Parkinson's Disease
Orthostatic hypotension is common in Parkinson's disease. The current recommended management of orthostatic hypotension related to Parkinson's disease involves first general measures and then medications with little risk of severe adverse side effects.
Neurogenic orthostatic hypotension is common in patients with Parkinson's disease. Perhaps, 30%–40% of patients with Parkinson's disease have orthostatic hypotension, and the prevalence rises with age, disease severity and disease duration. Orthostatic hypotension is defined as a drop in systolic blood pressure of ≥20 mm Hg or of diastolic blood pressure of ≥10 mm Hg, within 3 min of standing or upon head-up tilt (minimum 60°) on a tilt table.
In patients with Parkinson's disease, autonomic degeneration impairs the sympathetic response to baroreceptor input. During the course of Parkinson's disease, the accumulation of α-synuclein aggregates adds to the problems of neuronal degeneration and autonomic failure. Upon standing, many patients with Parkinson's disease cannot compensate for the venous pooling and reduced venous return caused by their compromised autonomic reflexes. Their subsequent drop in blood pressure causes presyncopal symptoms and difficulty in maintaining an upright posture.
The management of orthostatic hypotension in patients with Parkinson's disease is important because minimising this problem can improve cognition, balance and quality of life. Furthermore, treating orthostatic hypotension makes syncope less likely and so reduces the risk of falls and injury. Currently, the initial treatment is to remove iatrogenic causes (eg, antihypertensive medications) and to consider non-pharmacological interventions. Pharmacological interventions are needed only in a minority. In this review, we highlight both non-pharmacological and pharmacological options for managing orthostatic hypotension and analyse the extent to which these treatments help the problem.
Abstract and Introduction
Abstract
Orthostatic hypotension is common in Parkinson's disease. The current recommended management of orthostatic hypotension related to Parkinson's disease involves first general measures and then medications with little risk of severe adverse side effects.
Introduction
Neurogenic orthostatic hypotension is common in patients with Parkinson's disease. Perhaps, 30%–40% of patients with Parkinson's disease have orthostatic hypotension, and the prevalence rises with age, disease severity and disease duration. Orthostatic hypotension is defined as a drop in systolic blood pressure of ≥20 mm Hg or of diastolic blood pressure of ≥10 mm Hg, within 3 min of standing or upon head-up tilt (minimum 60°) on a tilt table.
In patients with Parkinson's disease, autonomic degeneration impairs the sympathetic response to baroreceptor input. During the course of Parkinson's disease, the accumulation of α-synuclein aggregates adds to the problems of neuronal degeneration and autonomic failure. Upon standing, many patients with Parkinson's disease cannot compensate for the venous pooling and reduced venous return caused by their compromised autonomic reflexes. Their subsequent drop in blood pressure causes presyncopal symptoms and difficulty in maintaining an upright posture.
The management of orthostatic hypotension in patients with Parkinson's disease is important because minimising this problem can improve cognition, balance and quality of life. Furthermore, treating orthostatic hypotension makes syncope less likely and so reduces the risk of falls and injury. Currently, the initial treatment is to remove iatrogenic causes (eg, antihypertensive medications) and to consider non-pharmacological interventions. Pharmacological interventions are needed only in a minority. In this review, we highlight both non-pharmacological and pharmacological options for managing orthostatic hypotension and analyse the extent to which these treatments help the problem.
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