Exploring Parkinson’s Disease’s Impact on Blood Pressure Control
On a recent episode of APDA’s Dr. Gilbert Hosts, I spoke with Dr. Jose Palma, a doctor with expertise in autonomic dysfunction and Parkinson’s disease (PD). Autonomic dysfunction is common in PD and refers to the dysregulation of body functions that are not under conscious control such as blood pressure, bowel function, and bladder function.
A common blood pressure issue for people with PD is orthostatic hypotension – a condition that prevents your body from properly increasing blood pressure when you change from lying to sitting to standing, which results in episodes of low blood pressure. These episodes of low blood pressure can cause a constellation of symptoms including most commonly dizziness, blurred vision, and even fainting. We talked in depth about this issue with Dr. Palma.
We covered a lot of ground during the broadcast and answered questions from the audience. It was a very informative conversation, and we encourage you to watch the full episode (just click the video below), but for your convenience, we’ve listed the topics and questions from the episode below with timestamps, so you can skip to what interests you most. Additionally, today we are answering some of the important questions that we didn’t have time to get to during the program.
Questions Addressed During the Episode:
00:16 Dr. Gilbert presents on autonomic dysfunction in PD
13:32 Introduction of Dr. Jose Alberto Palma
14:53 What are the effects of PD on the heart?
18:43 How can you treat someone who has high blood pressure sometimes and low blood pressure sometimes?
23:34 Is there a cause of dizziness that can happen when blood pressure is normal?
27:00 What do you do if blood pressure is very low, but you have no symptoms?
30:52 High intensity training is helpful to people with PD, but what if you get dizzy with intense exercise?
33:48 If someone has neurogenic orthostatic hypotension (NOH), does that suggest that they have multiple system atrophy, or could they still have PD?
35:27 Can fluctuations in dopamine medication absorption contribute to blood pressure dysregulation?
37:43 What are the symptoms when you have exercise intolerance, and the heart rate doesn’t increase sufficiently during exercise?
40:24 Is there any relationship between blood sugar and blood pressure?
43:47 What is the correct way to measure blood pressure to diagnose orthostatic hypotension?
46:09 What specialized testing is available to diagnose orthostatic hypotension?
48:17 Are there particular traits of fatigue that are associated with low blood pressure?
50:12 Can breathlessness be a symptom of low blood pressure?
52:01 Is there any foods or supplements that can help with temperature dysregulation?
53:26 What can help if you have one body part that feels very cold even though it is not cold to the touch?
Additional Questions About Blood Pressure Control and Parkinson’s Disease:
Our live audience was full of questions, and now we’ll answer some of the questions that we didn’t have time to address during the broadcast.
Q: If your blood pressure is extremely low, but you don’t have symptoms, is that a problem? Can low blood pressure cause damage in the body even if the person is not experiencing symptoms?
A: If you are not experiencing any symptoms such as dizziness, fainting, blurred vision, fatigue, breathlessness, or difficulty concentrating, then low blood pressure may not be a cause of concern. Typically, a person would experience these symptoms before the low pressure causes end-organ damage. However, it would be important to continue to monitor blood pressure to make sure that this problem is stable.
Q: Do autonomic symptoms occur individually or are they often grouped?
A: Autonomic symptoms in PD affect body functions that are not under conscious control, such as blood pressure regulation, digestion, and bladder control. These symptoms can occur in varying combinations and severity and do not travel together in a predictable pattern, with the presentation of autonomic symptoms varying widely among individuals with PD. So, one person may have blood pressure dysregulation along with urinary dysfunction, another may have only blood pressure dysregulation, and a third may have no autonomic non-motor symptoms at all.
Q: If my blood pressure tends to be low in the morning only, would it make sense to adjust PD meds to help with this?
A: Orthostatic hypotension in Parkinson’s disease can be due to the disease itself but can also be a side effect of PD medications. Therefore, one possible approach to improving this non-motor symptom, especially if it tends to occur at a specific time of day, is to adjust the timing of PD meds. If blood pressure is low in the morning, for example, delaying the first dose of PD meds may help. However, delaying the first dose of medication may mean that motor symptoms are prominent in the morning, which may be difficult to tolerate for the person with PD. Implementing lifestyle modifications in the morning, such as wearing compression stockings, and making gradual changes in posture to minimize blood pressure drops can be helpful steps to keep blood pressure from dropping.
Q: You mentioned that people with PD can experience exercise intolerance. What are the symptoms of exercise intolerance?
A: Exercise intolerance is the reduced ability of the body to perform strenuous activities. In PD, the heart rate may not be able to increase sufficiently during exercise due to dysfunction of the nerves that control the heart.
When the heart rate can’t increase, there is insufficient blood pumped during exercise, which can cause a variety of symptoms including:
- Chest pain
- Shortness of breath
- Excessive sweating
- Discoloration of the skin
- Leg cramps and muscle pains
- Severe fatigue.
Q: What is the best body position for sleep if you have low blood pressure?
A: The following are guidelines for how to sleep to maximize blood pressure during the day:
- Head of bed raised: Elevating the head of the bed may help reduce the severity of orthostatic hypotension during sleep. This can be achieved by using pillows or a wedge. If available, an adjustable hospital bed can allow a person to sleep at a head elevation of 30–45-degree angle.
- Legs flat or slightly elevated – with legs slightly elevated, blood that pooled in the legs during the day will return to circulation and allow for blood pressure to be maintained.
- Sleeping on the side – Some individuals find that sleeping on their side can be more comfortable and may help with blood circulation.
- And perhaps most importantly, when getting up from bed, do so gradually to allow the body to adjust to changes in posture, minimizing the risk of orthostatic hypotension.
Q: Should I take the medication that raises blood pressure on a regular schedule, or should I measure my blood pressure and only take the medication if my blood pressure is low?
A: Both approaches are common, so speak with your healthcare provider about which one is better for you. If your low blood pressure is very predictable, it makes sense for you to take the medications to raise your blood pressure on a regular schedule. However, for many, the blood pressure does not fall consistently. For these individuals, checking blood pressure and taking the medication only if it is lower than a particular threshold is a better strategy.
Q: How late in the day can I take the medication that raises my blood pressure?
A: The last dose of medication to raise blood pressure should be taken before the evening meal and at least approximately 3-4 hours before bedtime. If a person goes to bed too close to be taking medications that can raise blood pressure, supine hypertension (high blood pressure while lying down) can occur, which is associated with blurred vision, headaches, and pounding in the ears.
Tips and Takeaways
- Orthostatic hypotension is a common non-motor symptom in PD and can have a major impact on quality of life.
- Thankfully some potential treatments may help these symptoms including lifestyle modifications and medications.
- Listen to a very interesting broadcast dedicated to answering questions about blood pressure control and PD.
- If you have a PD-related question, you can submit it to our Ask A Doctor portal.