Blood Pressure

Check your blood pressure, please.

“Blood pressure decreases when blood vessels relax or lose their ability to constrict. If there is less fluid in the body, the circulating blood volume is decreased and blood pressure drops. Normal blood pressure range is usually 100/60 to 140/90. While some people will not experience any warning signals, drops in blood pressure below 100/60 may result in dizziness, lightheadedness, or weakness. If severe, hypotension can lead to fainting and/or falling. Individuals have also used terms such as giddiness, sleepiness, tiredness, and mental or visual blurring to describe what has actually turned out to be low blood pressure.

These sensations will often intensify upon standing or after walking. Although any time...”

[redhawk1]

Thanks RP!! Good info!

[Hidden in reply to redhawk1]

parkinson.org/sites/default....

[park_bear]

This brief snippet does not do the matter justice. This is possibly referring to orthostatic hypotension which is a neurological problem resulting in the loss of 20 points or more in systolic blood pressure upon standing. This can be caused by meds or Parkinson's itself.

On the other hand it is possibly referring to uniformly low blood pressure which is a completely different matter.

[Hidden in reply to park_bear]

Caused by daily dose over 800mg carbidopa

[Hidden in reply to park_bear]

parkinson.org/sites/default...

[LeharLover62]

At my husband’s movement disorder specialist appointments, they always check seated BP and then standing BP after 2 minutes.

Unfortunately, his will sometimes drop on standing causing near faints, at this point in the disease, in spite of being completely off of levodopa. His MDS therefore encourages keeping his BP on the high side (around 140 over 90).

Thanks for posting! It’s important to watch.

[park_bear in reply to LeharLover62]

Orthostatic hypotension can be caused by Parkinson's itself or by dopamine agonists. Levodopa has also been blamed, but this recent study found no association between levodopa and orthostatic hypotension:

journals.viamedica.pl/neuro...

Is your husband taking any dopamine agonists?

It is great that they check him for orthostatic hypotension but their advice is a long way from optimal. First of all you should have your own blood pressure cuff to monitor any interventions to raise his blood pressure.

Orthostatic hypotension is the result of impairment of the postural blood pressure regulation system. There is also a long-acting blood pressure regulation system that slowly operates over a period of hours. During the day when he is not lying down the blood pressure is too low. As result it slowly rises during the course of the day and peaks in evening. At night when he is lying down blood pressure is too high and slowly drops. It reaches its nadir upon waking in the morning.

Excess blood pressure upon reclining in the evening is a danger that must be monitored. When I suffered orthostatic hypotension my evening supine systolic blood pressure was over 200. I slept reclining instead of flat for that reason. Is essential to check his blood pressure upon reclining in the evening for this reason.

Any intervention to raise his blood pressure should only be taken first thing in the morning. The simplest intervention is to drink a quart or liter of isotonic saline at that time. Plain water works poorly because it is quickly excreted to maintain a proper concentration of electrolytes in the blood. Isotonic saline is made by adding 8 grams of salt to 1 quart of water, or 9 g to 1 L. That raises the blood volume and therefore increases blood pressure.

You should only be taking measures to raise his blood pressure after you have confirmed his evening supine blood pressure is not dangerously high.

[LeharLover62 in reply to park_bear]

Thanks! Yes it can be high at night but so far not as high as 200. And he sleeps on an elevated pillow.

He is no longer on dopamine agonists either since starting Mannitol. Of course, he did take these for for 12 years or so early in the disease, so who knows?

So far, he avoids heat, and uses Gatorade to help elevate pressure. His neuro also recommends cold water during faints, and nurses recommend moving the feet a lot before standing. Compression socks and belts have seemed to be more trouble than help.

[park_bear in reply to LeharLover62]

Glad you are monitoring his blood pressure! Exercising his feet and legs before standing makes sense. I never was inclined to try the compression garments..

There are all kinds of versions of Gatorade. I picked "orange" at random and found this: gatorade.com/hydration/thir...

"1 Packet (35g)/Makes about 20 fl oz.

Total Sugars 32g ... Ingredients: Sugar, Dextrose, Citric Acid, Salt, Sodium Citrate, Natural And Artificial Flavor, Monopotassium Phosphate, Calcium Silicate, Modified Food Starch, Caramel Color, Red 40"

Almost entirely sugar is not so good. See my writing here about the effect of excess carbohydrate consumption:

Sugar, Fat And Cardiovascular Disease tinyurl.com/y5cfmygz

FWIW, The isotonic saline first thing in the morning was a good intervention for me.

[M-o-ggy in reply to park_bear]

Hi there. You write as if you no longer have low blood pressure. Is that the case and how did you solve the problem?

[park_bear in reply to M-o-ggy]

It is true I am no longer suffering from low blood pressure as a result of orthostatic hypotension. In my case the problem was caused by a dopamine agonist and recovery ensued naturally as result of discontinuing it.

[M-o-ggy in reply to park_bear]

Would Entacapone be an agonist?

[park_bear in reply to M-o-ggy]

No it is not. It is a COMT inhibitor which slows the destruction of dopamine.

[M-o-ggy in reply to park_bear]

Thank you

[Hidden in reply to M-o-ggy]

Hi M-o-ggy:

You may find this interesting:

"PRECAUTIONS

Hypotension, Orthostatic Hypotension, And Syncope

Dopaminergic therapy in Parkinson's disease patients has been associated with orthostatic hypotension. Entacapone enhances levodopa bioavailability and, therefore, might be expected to increase the occurrence of orthostatic hypotension. In controlled studies, approximately 1.2% and 0.8% of 200 mg entacapone and placebo patients, respectively, reported at least one episode of syncope. Reports of syncope were generally more frequent in patients in both treatment groups who had an episode of documented hypotension."

rxlist.com/comtan-drug.htm

[M-o-ggy in reply to Hidden]

Thank you

[park_bear in reply to LeharLover62]

Also CoQ10 has been shown to relieve orthostatic hypotension. See:

healthunlocked.com/cure-par...

[LeharLover62 in reply to park_bear]

Great to know! Seems worth a try.

[Vik38]

My husband's latest set-back is dizziness on standing from sitting position. A month ago his GP found he had low blood pressure but said nothing more. He's on 4 x 62.5 Modopar and 8mg Ropinirole. Main symptom is left foot not responding so well in the afternoon so dragging foot. This week he's tried cutting back on Modopar thinking of possible overdosing causing gait problems - in the morning he's pretty good after first tab at 7 (12 hours after last one). Skipping last tablet at 7pm seemed non conducive- gait difficulty in the morning. Have just read lots of things about dizziness. And am tempted to try him on 9g/l salt water in the morning to start with. Was wondering if the Ropinirole is "guilty" of causing this dizziness. As with much of this medication, the side effects are often the same as the symptoms being treated. So difficult to know it it's PD, tablets or something else.