From the Guidelines
Orthostatic hypotension in Parkinson's disease that resolves with movement is primarily caused by autonomic nervous system dysfunction, which impairs the body's ability to regulate blood pressure effectively, and can be exacerbated by medications used to treat Parkinson's. The condition is characterized by a significant drop in blood pressure upon changing positions, particularly when standing up from sitting or lying down. In Parkinson's disease, this autonomic dysfunction leads to orthostatic hypotension, which can cause dizziness, lightheadedness, and other symptoms that often improve with movement due to the temporary increase in blood pressure and stimulation of blood flow that physical activity provides 1. Management strategies for orthostatic hypotension in Parkinson's disease include non-pharmacologic measures such as staying hydrated, increasing salt intake if appropriate, wearing compression stockings, and rising slowly from seated positions, as well as pharmacologic interventions like midodrine or fludrocortisone to raise blood pressure 1. It's also important for patients to discuss these symptoms with their neurologist, as adjustments to medication timing or dosage may help reduce the severity of orthostatic hypotension 1. Some key points to consider in managing orthostatic hypotension include:
- Encouraging increased salt and fluid intake, if appropriate, to help improve blood pressure and reduce symptoms 1
- Using compression garments, such as thigh-high stockings, to help improve orthostatic tolerance and reduce symptoms 1
- Avoiding medications that can worsen orthostatic hypotension, and adjusting medication regimens as needed to minimize this risk 1
- Encouraging physical activity and exercise to avoid deconditioning, which can exacerbate orthostatic intolerance 1
From the FDA Drug Label
The mechanism of orthostatic hypotension induced by ropinirole is presumed to be due to a D2-mediated blunting of the noradrenergic response to standing and subsequent decrease in peripheral vascular resistance. The cause of orthostatic hypotension in Parkinson's disease (PD) that resolves with movement is not explicitly stated in the provided text to be directly related to the resolution with movement. However, the mechanism of orthostatic hypotension induced by ropinirole is presumed to be due to a D2-mediated blunting of the noradrenergic response to standing and subsequent decrease in peripheral vascular resistance 2.
- Key points:
- Orthostatic hypotension is associated with ropinirole treatment.
- The exact cause of resolution with movement is not directly addressed in the provided text.
- D2-mediated blunting of the noradrenergic response is the presumed mechanism of orthostatic hypotension.
- Patients with Parkinson's disease may have an impaired ability to respond normally to a fall in blood pressure after standing from lying down or seated position 2.
From the Research
Orthostatic Hypotension in Parkinson's Disease
- Orthostatic hypotension (OH) is a common symptom in Parkinson's disease (PD) patients, affecting up to 20% of patients 3.
- The high prevalence of OH in PD patients can be attributed to two factors: dopaminergic drugs that may induce or worsen OH, and primary autonomic failure due to the involvement of the peripheral autonomic system 3.
- Autonomic abnormalities, including OH, can appear from the first stage of the disease, and early onset of symptomatic OH can be considered an exclusion criterion for idiopathic Parkinson's disease 3.
Pathophysiology of Orthostatic Hypotension
- The pathophysiology of OH in PD involves impaired sympathetic nerve activity, leading to neurogenic OH 4.
- The correction of non-neurogenic causes and exacerbating factors, lifestyle changes, and non-pharmacological measures are the cornerstone of OH treatment 4.
- Pharmacological interventions, such as sympathomimetic agents and/or fludrocortisone, may be introduced stepwise depending on the severity of symptoms 4.
Relationship between Orthostatic Hypotension and Movement
- There is no direct evidence in the provided studies that explains why orthostatic hypotension in Parkinson's disease resolves with movement.
- However, it is known that movement and physical activity can help improve blood flow and increase blood pressure, which may help alleviate symptoms of OH 4.
- Further research is needed to fully understand the relationship between movement and OH in PD patients.
Other Factors Contributing to Dizziness in Parkinson's Disease
- Dizziness in PD patients can also be associated with vestibular function, as shown by reduced vestibular evoked myogenic potentials (VEMPs) in patients with dizziness 5.
- Benign paroxysmal positional vertigo (BPPV) can also be a cause of dizziness in PD patients, affecting up to 11% of patients with symptoms of dizziness 6.