Navigating Orthostatic Hypotension in Clients with Parkinson’s Disease

by Shelley Hockensmith, PT, DPT, Physical Therapist Board Certified Neurologic Clinical Specialist

For exercise and movement specialists, orthostatic hypotension can be a challenging obstacle. We know we need to keep our clients moving, but that can be a difficult task when they develop lightheadedness when they stand! Low blood pressure upon standing can cause falls and injury, fear of movement, and secondary health decline from inactivity. Let’s explore the cause, how to help immediately, and recommendations for long-term management.  

First, we start with a review of orthostatic hypotension (OH). OH presents as fatigue, lightheadedness, dizziness, visual disturbance, and in some cases, loss of consciousness after sitting up or standing. This is due to insufficient blood vessel response to a gravity-related position change. In the PD population, it can be neurogenic (PD-related sympathetic nervous system changes) or non-neurogenic (dehydration, cardiac conditions, anemia, or certain medications).

To diagnose OH, blood pressure is taken in supine then again in standing. If systolic pressure drops more than 20mmHg or diastolic drops more than 10mmHg within three minutes, this is considered OH. Neurogenic versus nonneurogenic OH can be determined by monitoring heart rate response. This is calculated in a ratio of change between systolic blood pressure and heart rate. Click here to find out more about calculating systolic blood pressure compensation ratio  

How can we help our PD clients with OH?  

Here are some strategies to help during an episode: 

• Drink water (0.5L is recommended).
• Contract leg muscles using exercises such as glut squeezes or thigh adduction.
• Recover in supine or with the head elevated, then rise slowly.
• Try compression wear like an abdominal binder.

Here are some day-to-day management strategies: 

• Stay hydrated throughout the day.
• Avoid large meals, especially high in carbohydrates. Opt for frequent, smaller meals with lower carb counts.
• Increase salt consumption, if medically appropriate.
• Track low blood pressure events including time, position, recent meals, and medication schedule. Communicate concerns with the physician.
• Keep exercising! Consider recumbent machines for reassurance and safety, but don’t stop moving.

For more detailed information about OH and PD, here are two useful articles:

Kim MJ, Farrell J. Orthostatic Hypotension: A Practical Approach [published correction appears in Am Fam Physician. 2022 Oct;106(4):365.]. Am Fam Physician. 2022;105(1):39-49.

Palma JA, Kaufmann H. Orthostatic Hypotension in Parkinson Disease. Clin Geriatr Med. 2020;36(1):53-67.