Orthostatic hypotension in Parkinson's disease

Abstract

Abstract: Orthostatic hypotension (OH) is a frequent non-motor symptom in Parkinson’s Disease (PD) affecting between 22.9 and 38.4% of patients. OH is related in PD to increased risk of falls and possibly to cognitive dysfunction and increased mortality. These data emphasizes the importance of its prompt recognition and treatment. OH is related to pre-ganglionic and post-ganglionic adrenergic denervation, but other factors such as drugs, heat, meals or alcohol intake might also induce or aggravate it. Evidence about the efficacy and safety of pharmacological or non-pharmacological strategies for OH treatment in PD is weak. Non-pharmacological measures include liberal addition of salt to the diet, exercise, compression stocking or physical maneuvers. Severe cases may be treated with midodrine or fludrocortisone. Some results suggest that droxidopa and fipamezole might be effective treatments. We finish this review article by discussing the most important unanswered questions about PD-related OH, which might be the focus of future research