Low Blood Pressure

The primary blood pressure related symptom of PD is orthostatic hypotension.  Orthostatic hypotension is the term used when blood pressure drops upon standing from sitting, or upon sitting from lying down.  The low blood pressure of orthostatic hypotension can cause dizziness, lightheadedness, and maybe even fainting (syncope).

Downloadable Documents | Online Articles | Podcasts & Webinars | Expert-level Resources

Downloadable Documents (PDF)

Living with Postural Hypotension

Published by MSA Trust, April 2015

This 7-page fact sheet (PDF) was developed for people affected by MSA, but is just as useful to those with Parkinson’s disease, who are experiencing drops in blood pressure and postural hypotension.  It covers symptoms, when they are likely to happen, what to do, exercise and other tips for daily living with OH, including medication options.

Low Blood Pressure in Parkinson's Disease

Published by the Parkinson's Foundation

This 2-page article (PDF) discusses the frequency of orthostatic hypotension in those with PD, the cause, symptoms and several simple measures that can be used to restore normal blood pressure regulation, including medication evaluation, increase of fluids and salty foods, caffeine, frequent small meals, environment, clothing, slow position change, bed position and medication options.

Orthostatic Hypotension in Parkinson’s Disease: Essential Facts for Patients

Published by the International Parkinson and Movement Disorder Society, 2019

The 2-page fact sheet (PDF) explains orthostatic hypotension (OH) symptoms, some causes, what Parkinson’s patients can do to improve OH problems, medications that treat OH, and what to do when Parkinson’s patients experience OH.  Photos of physical countermeasures are included.

Online Articles

Effects of Parkinson’s Disease on Blood Pressure

Published by the Parkinson’s Association of Ireland, March 2012

This short web page explains the physical operation of blood pressure in the body, symptoms of low blood pressure and when they are most likely to occur, why low blood pressure is dangerous, medical treatments and lifestyle strategies to cope with low blood pressure, and a reminder that low blood pressure can affect the ability to drive safely.

nOH Matters.com

Published by Lundbeck Pharmaceuticals.

This website explains neurogenic orthostatic hypotension (nOH) falls under a larger category called orthostatic hypotension (OH), also known as postural hypotension.  nOH affects those with autonomic nervous system disorders.  The site provides a symptom checker, an nOH specialist locator tool, management options, an educational video.    

Science News: New Guidelines for Treating Orthostatic Hypotension in PD

Published by the Parkinson’s Disease Foundation (Now the Parkinson's Foundation), June 2, 2015

This 2-page article highlights findings in a study published in Movement Disorders February 12, 2015 updating diagnosis and treatment guidelines for people with Parkinson’s disease (PD) who experience orthostatic hypotension (OH).

What’s Hot in PD? If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications

By Michael S. Okun, MD.  Published by the National Parkinson Foundation (Now the Parkinson's Foundation), July 2011

This 3-page article, with references, is a personal statement by Dr. Okun describing the mis-diagnoses Parkinson’s patients can be given when visiting the ER for symptoms of dizziness or syncope (passing out); outlining what defines a proper diagnosis of orthostatic hypotension, its frequency in people with Parkinson’s, medication and lifestyle changes that can help.

Podcasts & Webinars

Blood Pressure and Parkinson’s: What’s the Connection?

By the Michael J. Fox Foundation Third Thursdays Webinar, October 20, 2016

This 60-minute audio with slides is an interview of two neurologists and a person with Parkinson’s discussing the symptoms, causes, and how to mitigate episodes of low blood pressure, as well as high blood pressure and recent Phase III trial testing of the high blood pressure medication, isradipine, to slow Parkinson’s disease progression without lowering blood pressure too much.  [Registration is required, but is free.]

From Low Blood Pressure to Bladder Problems: A Look at Lesser-Known Parkinson's Symptoms

By the Michael J. Fox Foundation, June 16, 2022

In this 60-minute audio with slides, expert panelists including two movement disorder specialists and person with Parkinson's, discuss autonomic issues in Parkinson's disease. Symptoms such as low blood pressure, bladder problems, constipation and sweating — as well as ways to treat them are discussed.  [Registration is required, but is free.]

How to Manage Dysautonomia in Parkinson's Disease

By Parkinson's Resources of Oregon, March 2023

In this 40-minute talk David Goldstein, MD, PhD, explains neurogenic orthostatic hypotension (nOH) in Lewy Body diseases (PD/LBD), the cardiac noradrinergic deficiency in PD/LBD, the relationship between intra-neuronal alpha-synuclein in skin biopsies and cardiac noradrenergic deficiency in PD/LBD forms of nOH, and treatment of nOH (patient/caregiver education, non-drug, drugs). 

Introduction to Dysautonomia

By Parkinson's Resources of Oregon, March 2023

In this 45-minute talk David Goldstein, MD, PhD, with the National Institutes of Health, provides an in depth look at the science of the Autonomic Nervous System (ANS) and Dysautonomia. One effect of dysautonomia in PD is neurogenic orthostatic hypotension (nOH), or low blood pressure.

Managing Blood Pressure in PD

By the Parkinson’s Foundation, June 5, 2020

In this 1-hour webinar, neurologist Albert Hung discusses how PD impacts blood pressure (BP) regulation, how to diagnose BP issues, and approaches to treating BP in those with PD.  There is a short question and answer session as well. 
Webinar notes on the Stanford PD Community Blog

Neurogenic Orthostatic Hypotension - Medical Animation

By the Treat Neurogenic Orthostatic Hypotension Now Coalition, July 30, 2013

This 5-minute video uses medical animation to demonstrate how neurogenic orthostatic hypotension occurs in Parkinson’s disease, Multiple System Atrophy, and other neurodegenerative disorders; including symptoms, and diagnostic parameters.

nOH (neurogenic orthostatic hypotension or "dizzyness") in Parkinson's

By the Davis Phinney Foundation, November 5, 2022

In this one-hour webinar, movement disorder specialist Salima Brillman, MD, explains what nOH is and how it is diagnosed. She shares lifestyle changes, medication options, quick tips, and answers listener questions throughout. A must-listen for those struggling with nOH.

Orthostatic Hypotension in Parkinson’s Disease, Multiple System Atrophy, and Lewy Body Dementia

By the Stanford Movement Disorder Center and Brain Support Network, September 18, 2017

Movement disorder specialist, Dr. Veronica Santini spoke for a half hour on orthostatic hypotension, a common symptom of Parkinson’s disease, Multiple System Atrophy and Lewy Body Dementia.  Following her talk, moderator Candy Welch, Brain Support Network’s MSA caregiver support group leader, presented Dr. Santini with questions from webinar participants for another half hour. 
Webinar notes on the Brain Support Network Blog

Orthostatic Hypotension in PD

By the Stanford Movement Disorder Center, December 14, 2022

Autonomic specialist with Stanford Neurology, Mitch Miglis, MD, described what causes orthostatic hypotension (OH), how OH manifests, and treatment (both pharmacological and non-pharmacological).  There were lots of good questions from attendees. Dr. Miglis also shared an "orthostatics log," for tracking blood pressure at home. 

Understanding Blood Pressure Fluctuations in Parkinson's Disease

By APDA Massacheusetts, August 10, 2021

In this 1-hour webinar Anindita Deb, MD, Movement Disorder Specialist, provides an overview of the human nervous system, which controls blood pressure, before explaining what orthostatic hypotension (nOH) is, how to monitor nOH, medications that can affect blood pressure, lifestyle changes to improve nOH, how nOH affects cognition and mobility.  She then spends considerable time sharing physical maneuvers and medications to treat nOH before answering listener questions.

Understanding Orthostatic Hypotension

By the Houston Area Parkinson Society, July 2020

Orthostatic hypotension (OH) is low blood pessure.  In this talk Olga Waln, MD, spent about 15 minutes explaining why OH happens, the impact of OH on quality of life, what symptoms you may experience, and how OH is diagnosed.  She spent another 10 minutes sharing  suggestions for lifestyle changes and medications to treat OH.  Finally, Dr. Waln answered questions for 20 minutes.

Expert-Level Resources

Assessment and Management of Orthostatic Hypotension in Parkinson’s Disease

Annals of Indian Academy of Neurology, July 14, 2011

This 1-page article, with references, explains the failure of the autonomic nervous system causing orthostatic hypotension, its specific definition, clinical profile, diagnostic method, and management to prevent falls.

Orthostatic Hypotension in Patients with Parkinson’s Disease and Atypical Parkinsonism

By Seyed-Mohammed Fereshtehnejad and Johan Lokk.  Hindawi Publishing Corporation, February 2, 2014

This article outlines a study which reviewed current evidences on epidemiology, diagnosis, treatment, and prognosis of orthostatic hypotension (OH) in patients with idiopathic Parkinson’s disease and atypical parkinsonism.  Conclusions include recommendation for further study of OH and routine screening for timely diagnosis and further assessments beyond the recommended 3 minute postural challenge currently used.

Preventing and treating orthostatic hypotension: As easy as A, B, C

By Juan J. Figueroa, MD, Jeffrey R. Basford, MD, PhD, and Phillip A. Low, MD.  Cleveland Clinic Journal of Medicine, May 2010, 77(5): 298-306

Drug therapy alone is never adequate to treat orthostatic hypotension. A patient-oriented approach that emphasizes education and nonpharmacologic strategies is critical. This article provides easy-to-remember management recommendations, using a combination of drug and non-drug treatments that have proven effective.

Last updated August 2020 by Stanford Parkinson's Community Outreach.