Orthostatic hypotension is common in Parkinson disease, from both autonomic involvement and dopaminergic medication, and it is often silent or presents as falls, fatigue or slowed thinking rather than classic dizziness.
A lying and standing blood pressure at each review, with a standing reading at one and three minutes, picks it up. Finding it changes management: review antihypertensives and medicines that lower blood pressure, advise on fluids and posture, and consider whether a new dose of levodopa or a dopamine agonist is contributing.
- Measure lying and standing blood pressure at one and three minutes at each Parkinson review.
- Ask about falls, morning light-headedness and post-meal symptoms.
- Review antihypertensives and alpha-blockers when orthostatic hypotension is found.
- Consider whether a recent dopaminergic dose increase is contributing.
Why it matters
Unrecognised orthostatic hypotension is a treatable cause of falls in Parkinson disease.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free