Orthostatic Hypotension (positional low blood pressure) is the inappropriate lowering of blood pressure upon sitting upright or standing. This can be worse in the morning due to limited fluid intake and frequent urination overnight. Symptoms include lightheadedness, dizziness, weakness, fatigue, upset stomach, blurry vision, headache, and brain fog. Supine Hypertension (positional high blood pressure) is the inappropriate elevation of blood pressure when laying flat. These are common problems in those who have Parkinson’s Disease. This can be easily assessed at home with special blood pressure monitoring that is explained below.
Monitor blood pressure at home:
1) Purchase a blood pressure cuff that also takes your heart rate from a local pharmacy. Ask the pharmacist for their recommendation if they have one.
2) Take your blood pressure and heart rate after laying for 5 minutes to look for high blood pressure. You can skip this step after completing a few recordings.
3) Take your blood pressure and heart rate after being seated upright for 60 seconds.
4) Stand up and repeat your blood pressure and heart rate after 60 seconds to see if your blood pressure decreases.
5) Do these measurements first thing in the morning for 1 week.
6) If applicable, for the 2nd week take these measurements 60 minutes after your morning blood pressure medications.
7) Send your doctor a copy via MyChart of your blood pressure log.
There are other times to think about checking these blood pressure measurements. In these situations, it is generally okay to only check seated followed by standing blood pressure and heart rate measurements (that is, skipping lying down measurements):
∙ 1 to 2 hours after taking your PD medications or when you feel like they are working (that is, you feel “on”).
∙ If you feel anxious or “out of body” after taking your PD medications.
∙ If you have brain fog or feel “spacey” after taking your PD medications
∙ If you feel lightheadedness when standing up.
∙ If you feel sleepy after a meal.
∙ If you have a fall.
If your systolic blood pressure (top number) drops when you sit up or stand by >20 points, this is consistent with Orthostatic Hypotension. Most people can “feel” if they are systolic blood pressure is <100. If you systolic blood pressure (top number) is >140 when you are laying down, you may have Supine Hypertension — oftentimes we accept systolic blood pressures up to 160 (rarely up to 180), but this varies from person-to-person.
It is very important to stay hydrated and prevent dehydration. Drink at least 8 glasses (64 ounces) of water daily. People tend to be most dehydrated in the morning (due to not drinking water overnight and/or using the bathroom), so it is helpful to focus water intake in the morning. If one drinks caffeine (coffee or black tea), they should always drink 1 glass of water with it to offset its “diuretic” (increased urination) effect. Sometimes it will be recommend to add 1 to 2 teaspoons of salt to one’s diet as this helps one’s body hold onto its water, but this may not be a safe idea if someone has heart failure or other cardiac problems.
If needed, there are medications that “boost” blood pressures during the day when people are most active. If these medications are used, it is important not to lay down for a long period of time during the day as this may increase your blood pressure to an unsafe level. If someone wants to take a nap, it is safe to do so in a recliner or with the head of the bed raised to at least 20°. We try not to give these medications after 4 to 6pm because this can worsen supine hypertension (which is brought out by laying down to sleep).
Non-medication treatments:
- Drink at least 8 glasses (64 ounces, ~2 liters) of water daily. Try to focus water intake in the morning and limit intake after 8PM to reduce overnight urination.
- Consider adding 1-2 teaspoons of salt to your diet to help retain water.
- Do not stand up suddenly. Take your time when going from laying to standing up but first dangle your feet off the bed for 15 to 30 seconds. Try pre- and post-standing muscle activation maneuvers to stimulate circulation.
- Avoid large carbohydrate-rich meals in favor of more frequent small meals. Avoid alcohol as this can worsen low blood pressure.
- Tight high-waist compression stockings may be helpful (at least 15 to 20 mmHg of pressure needed).
- You may try “abdominal binders” to help shift blood away from your abdomen back into your circulation.
- If you have supine hypertension, try to sleep with the head of your bed at least 20° (preferably 30°) to limit high blood pressure. You may purchase an adjustable mattress or bed wedge to achieve this. Avoid laying down flat throughout the day as well. It is okay to use a recliner chair.
Triggers for orthostatic hypotension:
• Dehydration
• Early morning
• Hot weather
• Warm shower
• Large carbohydrate rich meals
• Caffeine, sugary beverages, and alcohol
• Urination or bowel movement
• Exercise
Treating orthostatic hypotension in the moment:
• Drink 12 to 16 ounces of water over 3 to 4 minutes.
• Try different body maneuvers including crossing your arms, doing calf raises, tightening your stomach, or simply sitting down.
• See “Feel lightheaded when standing? Try these simple exercises” on YouTube :
Author Mick Reedy, MD, is a Movement Disorders Specialist with
Inova Parkinson’s and Movement Disorders Center (IPMDC)