Abstract
Orthostatic hypotension (OH) affects at least 30% of people with Parkinson’s disease (PD) and should be tested for regularly. In addition to causing the expected symptoms of orthostatic light-headedness, dizziness, pre-syncope, and syncope, it may also present with orthostatic pain across the shoulders or low back pain, fatigue, mental fogginess, exertional shortness of breath, and falls without apparent loss of consciousness. The first step in treatment is reduction or elimination of drugs that cause OH, including those for PD and other nonneurologic conditions including hypertension. The second step is to educate patients about circumstances than exacerbate OH and employing non-pharmacologic treatment such as increasing water and salt intake, use of an abdominal binder, and propping the head up overnight. The third tier of management is medical therapy using one or more of fludrocortisone, midodrine, droxidopa, or pyridostigmine with awareness of side effects including supine hypertension. Treatment of OH relies on supine and standing BP readings taken in the context of patient symptoms.
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Reich, S.G. (2019). Treatment of Orthostatic Hypotension in Parkinson’s Disease. In: Reich, S., Factor, S. (eds) Therapy of Movement Disorders. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-319-97897-0_12
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DOI: https://doi.org/10.1007/978-3-319-97897-0_12
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