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Parkinson's disease (PD) is the most common movement disorder
.
In addition to specific motor symptoms, PD also causes many non-motor symptoms, such as dementia, chronic constipation, hyposmia, REM sleep behavior disorder, chronic fatigue, daytime sleepiness, and orthostatic intolerance
.
The most prominent manifestation of non-exercise symptoms is the change in blood pressure adjustment.
Today, let's learn how to deal with orthostatic hypotension (OH) caused by PD
.
Diagnostic criteria ➤ When the patient changes from the supine position to the upright position or the tilt test is 60 degrees, the systolic blood pressure drops ≥20mmHg (1mmHg=0.
133kPa) or the diastolic blood pressure drops ≥10mmHg, with or without orthostatic symptoms, such as dizziness, vertigo or fatigue
.
➤OH is affected by many factors, such as room temperature, excessive physical activity, food intake, and timing of blood pressure measurements
.
Therefore, the blood pressure must be measured in a standard state, the supine blood pressure requires the patient to rest for 15 minutes after the measurement, and the standing blood pressure requires the measurement within 3 minutes of standing
.
➤ A 1-min tilt test is sufficient to identify most patients with OH
.
But if OH occurs after standing for 3 minutes, it is called "late-onset OH"
.
Late-onset OH is considered an early sign of progressive adrenal failure, suggesting mild adrenergic damage
.
Pathophysiology ➤ Pathophysiology of the autonomic nervous system: The pathophysiology of PD is the loss of substantia nigra dopaminergic neurons and the formation of Lewy bodies in the brain, in addition, the insular cortex, hypothalamus, cerebellum, dorsal vagus nucleus, spinal cord.
Similar pathological changes were also seen in the mesolateral column, sympathetic ganglia, and intestinal muscularis and submucosa
.
These pathological changes in the areas that control autonomic nerve function are very similar to the pathological changes in pure autonomic nerve dysfunction, which can disturb the regulation of blood pressure by the cardiovascular reflex arc and cause abnormal sympathetic nerves that control ventricular muscle
.
Therefore, the patient's blood pressure cannot be adjusted in a timely and effective manner when the body position changes, resulting in the occurrence of OH
.
➤Adverse reactions of anti-PD drugs: Anti-PD drugs can induce or exacerbate OH and disrupt cardiovascular autonomic function
.
Almost all dopaminergic drugs disrupt the body's regulation of blood pressure and heart rate in an upright position
.
Evaluation and treatment ➤ Evaluation of OH Before the treatment of OH in PD patients, the degree of orthostatic intolerance should be evaluated first, as shown in Table 1
.
Items assessed included: the frequency and extent of the patient's OH symptom onset, the time the patient was able to stand before the onset of symptoms, the impact on daily activities, and the value of blood pressure measured
.
If a patient's OH is grade I, the patient does not require medical treatment, and if the grade is grades III and IV, further treatment should be given
.
Table 1 ➤Treatment of OH ➤Treatment of OH has 4 goals: to improve OH without increasing supine blood pressure; to prolong the time that patients stand; to relieve symptoms of OH; to improve the ability of patients with OH to perform daily upright activities
.
➤The standard treatment for OH begins with volume expansion
.
In the setting of hypovolemia, the application of vasoconstrictor drugs is ineffective
.
Fluid intake should be controlled at 1.
25~2.
50L/d, and salt supplementation is also necessary
.
Many patients with poorly controlled OH are severely deficient in salt intake
.
The amount of salt supplementation can be calculated by measuring the patient's 24-h urinary sodium concentration
.
When the patient's urinary sodium concentration is less than 170 mmol/24h, 1-2 g of salt can be given three times a day for supplementation, and the patient's symptoms, body weight and urinary sodium concentration can be checked again after 1-2 weeks
.
➤ For PD patients with OH, the head position should be elevated by 10 cm in bed to reduce the effects of nocturia and supine hypertension; position training can be repeated to gradually reduce the symptoms of OH
.
➤ In some patients, the use of tights and compression stockings can reduce OH and its accompanying symptoms
.
➤Drinking plenty of water quickly is an effective method for the treatment of OH emergencies
.
The patient can drink 500ml of water quickly, which can increase the systolic blood pressure in the standing position by more than 20mmHg and maintain it for 2h
.
➤ Limb exercise can also prolong the standing time of patients, including tiptoeing, crossing legs, bending over, lunge exercises, etc.
These methods can cause venous contraction to reduce venous blood volume and increase peripheral resistance, improve patients' OH and its symptoms
.
➤Drug therapy is an important part of the overall treatment and, if treated properly, will greatly improve the regulation of the body's blood pressure
.
The main treatment drugs are midodrine, pyridostigmine, droxidopa and domperidone
.
Conclusion The incidence of OH in PD patients is significantly increased due to the disease itself and the use of anti-PD drugs
.
Therefore, in the process of diagnosis and treatment of PD patients, some non-motor symptoms of PD patients, especially the possibility of OH, should be recognized, and early diagnosis and treatment should be carried out
.
At the same time, health education is carried out for PD patients, so that patients can recognize the harm of OH and actively prevent the occurrence of OH, avoid excessive blood pressure fluctuations, and minimize the adverse effects of OH on the body
.
References: [1] Hu Xiao, Bian Weiting, Yan Fuling, Liu Weiguo.
Orthostatic hypotension in patients with Parkinson's disease [J].
Journal of Clinical Neurology, 2012, 25(05): 388-390.
[2] He Yanjie , Zou Haiqiang.
The mechanism and treatment of orthostatic hypotension and supine hypertension in patients with Parkinson's disease [J].
Chinese Journal of Clinicians (Electronic Edition), 2013,7(24):11826-11829.
[3]Hu Xiao , Li Zhihong, Liu Weiguo, Yan Fuling.
Related risk factors of orthostatic hypotension and postprandial hypotension in patients with Parkinson's disease[J].
Journal of Clinical Neurology,2013,26(04):260-263.
.
In addition to specific motor symptoms, PD also causes many non-motor symptoms, such as dementia, chronic constipation, hyposmia, REM sleep behavior disorder, chronic fatigue, daytime sleepiness, and orthostatic intolerance
.
The most prominent manifestation of non-exercise symptoms is the change in blood pressure adjustment.
Today, let's learn how to deal with orthostatic hypotension (OH) caused by PD
.
Diagnostic criteria ➤ When the patient changes from the supine position to the upright position or the tilt test is 60 degrees, the systolic blood pressure drops ≥20mmHg (1mmHg=0.
133kPa) or the diastolic blood pressure drops ≥10mmHg, with or without orthostatic symptoms, such as dizziness, vertigo or fatigue
.
➤OH is affected by many factors, such as room temperature, excessive physical activity, food intake, and timing of blood pressure measurements
.
Therefore, the blood pressure must be measured in a standard state, the supine blood pressure requires the patient to rest for 15 minutes after the measurement, and the standing blood pressure requires the measurement within 3 minutes of standing
.
➤ A 1-min tilt test is sufficient to identify most patients with OH
.
But if OH occurs after standing for 3 minutes, it is called "late-onset OH"
.
Late-onset OH is considered an early sign of progressive adrenal failure, suggesting mild adrenergic damage
.
Pathophysiology ➤ Pathophysiology of the autonomic nervous system: The pathophysiology of PD is the loss of substantia nigra dopaminergic neurons and the formation of Lewy bodies in the brain, in addition, the insular cortex, hypothalamus, cerebellum, dorsal vagus nucleus, spinal cord.
Similar pathological changes were also seen in the mesolateral column, sympathetic ganglia, and intestinal muscularis and submucosa
.
These pathological changes in the areas that control autonomic nerve function are very similar to the pathological changes in pure autonomic nerve dysfunction, which can disturb the regulation of blood pressure by the cardiovascular reflex arc and cause abnormal sympathetic nerves that control ventricular muscle
.
Therefore, the patient's blood pressure cannot be adjusted in a timely and effective manner when the body position changes, resulting in the occurrence of OH
.
➤Adverse reactions of anti-PD drugs: Anti-PD drugs can induce or exacerbate OH and disrupt cardiovascular autonomic function
.
Almost all dopaminergic drugs disrupt the body's regulation of blood pressure and heart rate in an upright position
.
Evaluation and treatment ➤ Evaluation of OH Before the treatment of OH in PD patients, the degree of orthostatic intolerance should be evaluated first, as shown in Table 1
.
Items assessed included: the frequency and extent of the patient's OH symptom onset, the time the patient was able to stand before the onset of symptoms, the impact on daily activities, and the value of blood pressure measured
.
If a patient's OH is grade I, the patient does not require medical treatment, and if the grade is grades III and IV, further treatment should be given
.
Table 1 ➤Treatment of OH ➤Treatment of OH has 4 goals: to improve OH without increasing supine blood pressure; to prolong the time that patients stand; to relieve symptoms of OH; to improve the ability of patients with OH to perform daily upright activities
.
➤The standard treatment for OH begins with volume expansion
.
In the setting of hypovolemia, the application of vasoconstrictor drugs is ineffective
.
Fluid intake should be controlled at 1.
25~2.
50L/d, and salt supplementation is also necessary
.
Many patients with poorly controlled OH are severely deficient in salt intake
.
The amount of salt supplementation can be calculated by measuring the patient's 24-h urinary sodium concentration
.
When the patient's urinary sodium concentration is less than 170 mmol/24h, 1-2 g of salt can be given three times a day for supplementation, and the patient's symptoms, body weight and urinary sodium concentration can be checked again after 1-2 weeks
.
➤ For PD patients with OH, the head position should be elevated by 10 cm in bed to reduce the effects of nocturia and supine hypertension; position training can be repeated to gradually reduce the symptoms of OH
.
➤ In some patients, the use of tights and compression stockings can reduce OH and its accompanying symptoms
.
➤Drinking plenty of water quickly is an effective method for the treatment of OH emergencies
.
The patient can drink 500ml of water quickly, which can increase the systolic blood pressure in the standing position by more than 20mmHg and maintain it for 2h
.
➤ Limb exercise can also prolong the standing time of patients, including tiptoeing, crossing legs, bending over, lunge exercises, etc.
These methods can cause venous contraction to reduce venous blood volume and increase peripheral resistance, improve patients' OH and its symptoms
.
➤Drug therapy is an important part of the overall treatment and, if treated properly, will greatly improve the regulation of the body's blood pressure
.
The main treatment drugs are midodrine, pyridostigmine, droxidopa and domperidone
.
Conclusion The incidence of OH in PD patients is significantly increased due to the disease itself and the use of anti-PD drugs
.
Therefore, in the process of diagnosis and treatment of PD patients, some non-motor symptoms of PD patients, especially the possibility of OH, should be recognized, and early diagnosis and treatment should be carried out
.
At the same time, health education is carried out for PD patients, so that patients can recognize the harm of OH and actively prevent the occurrence of OH, avoid excessive blood pressure fluctuations, and minimize the adverse effects of OH on the body
.
References: [1] Hu Xiao, Bian Weiting, Yan Fuling, Liu Weiguo.
Orthostatic hypotension in patients with Parkinson's disease [J].
Journal of Clinical Neurology, 2012, 25(05): 388-390.
[2] He Yanjie , Zou Haiqiang.
The mechanism and treatment of orthostatic hypotension and supine hypertension in patients with Parkinson's disease [J].
Chinese Journal of Clinicians (Electronic Edition), 2013,7(24):11826-11829.
[3]Hu Xiao , Li Zhihong, Liu Weiguo, Yan Fuling.
Related risk factors of orthostatic hypotension and postprandial hypotension in patients with Parkinson's disease[J].
Journal of Clinical Neurology,2013,26(04):260-263.
