By Liz Yates Horton PT, DPT, NCS
Drops in blood pressure when changing positions like getting out of bed or standing from a chair is called orthostatic hypotension. This condition can occur in Parkinson’s Disease due to decreased vasoconstriction and cardiac output with position changes. This is diagnosed if there is more than a 20 point drop in your blood pressure when changing positions in either the top number (systolic) or a 10 point drop in bottom number (diastolic).
There are several strategies you can do to help combat this and improve safety when moving.
Aim for 8-10 8 ounce glasses of fluid, such as water, Gatorade, V8 juice, per day, if you do not have a heart or kidney condition.
A strategy that may work is either filling up a gallon container in the morning with the goal of drinking the contents by the end of the day or having a goal of a certain number of bottles of fluid to consume daily.
Coffee does not count towards your fluid intake. Caffeine and alcohol can lower blood pressure and worsen dehydration.
Salt may be a helpful tool to keep your blood pressure up. This can be using table salt, having salty foods like canned soup or using over the counter salt tablets as directed by your physician.
Eating frequently with small meals can help keep your blood pressure level. Some people can become hypotensive within 2 hours of eating.
It may be helpful to track when you are having drops in your blood pressure as there may be a pattern such as in the morning or after a big meal.
Wearing compression stockings or an abdominal binder may be beneficial. The ideal amount of compression needed for stockings is 30-40 mmHG (mmHg is how the amount of compression is measured). You can start with over the counter compression stockings which are usually 10-15 mmHg. These can be challenging to put on and take off independently. It may be beneficial to work with an occupational therapist to develop strategies to improve ease.
Avoid prolonged standing or sitting.
Raise the head of the bed at night, use more pillows, or a wedge pillow. The goal is to be elevated 30 degrees.
Drink a full, cold glass of water prior to standing up.
Avoid increasing your core body temperature from activities such as use of hot tubs or saunas, and being outside in humid hot weather.
Engage in regular physical exercise.
When changing positions try using these counterpressure maneuvers. The purpose of these is to assist with returning blood back to the heart prior to changing positions.
There are also medications that may help so it is helpful to mention to your physician this is occurring. These medications include midodrine, fludrocortisone, pyridostigmine and droxidopa.