It is often heard that patients with Parkinson disease complain about such a phenomenon: they often suffer from dizziness, weakness and blackness in front of their eyes. They must lie down and rest to alleviate it, and even faint; It seems that each time it occurs after standing or sitting for a long time. Some patients find that it occurs more than 1-2 hours after eating. They suspected that they had a cerebral infarction, but went to the hospital for film examination, and there was no obvious abnormality in the brain. What’s going on?
In fact, these symptoms are related to Parkinson’s disease, called orthostatic hypotension. They are caused by the decrease of blood pressure and cerebral blood flow caused by changes in body position (such as sudden change from supine position to upright position, or standing for a long time). They are one of the common non motor symptoms of Parkinson’s disease. In the early stage of Parkinson’s disease, one third of patients will have orthostatic hypotension, and the incidence will gradually increase with the progress of the disease. It is mainly manifested in dizziness, dizziness, blurred vision, irritability, general weakness, etc. when the cerebral perfusion is seriously reduced, there may be speech disorder, decreased level of consciousness, and even syncope. It can be found that the patient’s blood pressure is normal when lying, and the blood pressure measured when standing drops by 20-40mmhg or more. Generally, there is no change in heart rate.
Because orthostatic hypotension will increase the possibility of falls and other accidents in patients with Parkinson’s disease, aggravate patients’ cognitive impairment, reduce patients’ life function and increase the mortality of Parkinson’s disease, it is very important to find and intervene in time.
What if patients with Parkinson’s disease have orthostatic hypotension?
1,First, the doctor will sort out all the drugs taken by the patient, reduce or stop the drugs that will aggravate orthostatic hypotension and reduce the interaction between drugs.
2,Non drug therapy: it is recommended that patients combine some simple lifestyle changes in daily life to control the symptoms caused by orthostatic hypotension.
Increase the intake of water and salt. It is recommended to drink more than 2L of water every day; It is recommended that the daily diet contain 1-2 teaspoons of salt, but patients at risk of heart failure or severe peripheral edema should pay attention to salt intake; It is not suitable to soak in overheated bathtub, hot spring and sauna; Low intensity physical strength and moderate non strenuous activities are recommended; Avoid high-intensity exercise and exercise in high temperature and high humidity environment; Eat less and more meals, low sugar diet; quit drinking; Raising the head of the bed by 15-23cm can relieve lying hypertension; Do not stand up quickly from the lying or sitting position; Elastic pants or elastic socks can resist the change of blood pressure caused by postural venous stasis, improve venous reflux, and increase blood pressure by 30-40mmhg;
3,Drug therapy: drug therapy can be used when the effect of non drug therapy is poor. At present, the drugs that can be used mainly include midodrine hydrochloride, droxidoba, fluhydrocortisone, bromopyrimidine and domperidone. However, these drugs have potential side effects, among which supine hypertension is the most common. Therefore, the application timing and dose of the above drugs must be carried out under the guidance of specialists.