Stanford PD Community Blog

Stanford Parkinson's Community
  • Home
You are here: Home / Webinars - Announcements & Notes / “Blood Pressure Issues” – Lecture Notes

“Blood Pressure Issues” – Lecture Notes

November 16, 2020 By Parkinson's Community Help

The Multiple System Atrophy Coalition offered a two-day conference in late-October on various aspects of multiple system atrophy (MSA), which is a disorder similar to Parkinson’s disease (PD) (MSA is called an atypical parkinsonism disorder). One of the talks, presented by Tom Chelimsky, MD, a neurologist at Wisconsin Medical College, focused on blood pressure issues in multiple system atrophy patients, but his advice applies to Parkinson’s patients. 

Dr. Chelimsky also provided advice on managing the blood pressure decrease when rising from sitting or lying down to standing. Since this symptom is common in both MSA and PD patients, these solutions apply to both groups. Treatments for low blood pressure include drinking adequate water, managing salt intake, and exercising regularly.

This talk is different from the “Neurogenic Orthostatic Hypotension” lecture I attended at the same conference (and for which I will share notes soon). Dr. Chelimsky’s lecture focused more on exercise and non-pharmacological treatments for low blood pressure issues, whereas Dr. Kompoliti’s lecture emphasized monitoring orthostatic hypotension and lifestyle choices that can be changed to help low blood pressure.

To watch this webinar, go here and click “Register Now.” Follow the instructions and email link, then return to the conference website. If you are logged in, you can access this link to view the recording.

Dr. Chelimsky’s talk begins at timestamp 1:22:59.

Here are the slides for Dr. Chelimsky’s talk: (at this time, these 28 slides can *only* be viewed or downloaded if you are logged in to the conference)

Dr. Chelimsky also put together a 5-minute video of him speaking about the pharmacological treatment (fludrocortisone, midodrine, pyridostigmine, droxidopa) and non-pharmacological treatment of orthostatic hypotension: (again, at this time, this short recording can *only* be viewed or downloaded if you are logged in to the conference)

Stanford Parkinson’s Community Outreach has a lot of resources on low blood pressure for people with Parkinson’s here.

I listened to this webinar and am sharing a summary of the talk below. 

– August Besser


“Blood Pressure Issues in MSA” – Lecture Notes

Speaker: Tom Chelimsky, MD, neurologist, Medical College of Wisconsin

Conference Host: Multiple System Atrophy Coalition

October 24, 2020

Summary by August Besser, Stanford Parkinson’s Community Outreach

Does Autonomic Function Do Much?

  • Imagine there is a sudden bad traffic jam.
    • The first person is in a Porsche taking a pleasant stroll to the country; their blood pressure and heart rate remain steady.
    • The second person, driving a SEAT, is unemployed and on their way to their first interview in a year; their blood pressure and heart rate rise and they might have a urinary/fecal urgency.
  • The autonomic nervous system harmonizes the brain and the body
  • These coordinating centers degenerate in Multiple System Atrophy (MSA)

Who works harder to get blood to their brain? A man or a giraffe?

  • How much blood is below the heart (pump)?
  • Man: 75% of their blood is below the heart

How often does MSA happen?

  • Muscle system atrophy has a prevalence of 4.4 cases per 100,000 people
  • 58% of MSA patients develop Parkinsonian type
  • 29% of MSA patients develop cerebellar type
  • Compared to Parkinson’s disease: approximately 2,000 per 100,000 people, about 500 times more common

Synapses

  • Synapse: the way cells talk to one another
  • Axon (the talking end of the nerve cell) sends a signal to the dendrite (the listening end of the nerve cell)

Let’s focus on Orthostatic Hypotension: What is it?

  • A drop in blood pressure when you stand up of > 20 systolic mm Hg or >10 diastolic mm Hg
    • Symptoms: systolic drops below 100 or > 60 total drop in blood pressure
  • Problem: nerves to blood vessels don’t work; vessels stay open when you stand up
  • Problem: when your blood pressure falls, you may fall too!

The Baroreflex: How does it work?

  • Senses change in pressure: the blood pressure drop is sensed on the venous side of the right atrium, and the pressure rise is sensed on the arterial side of the aorta and carotids
  • Adjusts pressure by: vasoconstriction (increases norepinephrine) and vasodilation (increases nitric oxide)
    • These are opposite systems moving blood from the gut and skin to the main circulation; the moveable blood depends on a person’s setting (e.g., digestion, hot environment, etc.)
    • Causes increasing or decreasing heart rate
  • In MSA, the baroreflex fails us in 2 ways: when there is a need for higher blood pressure (resulting in orthostatic hypotension), or when there is a need for lower pressure (resulting in supine hypotension)

Beware! People with MSA may not know when their blood pressure drops

So, can you do anything? Yes, LOTS

  • The main failure is not selecting the wrong drug, but failure to back up the drugs with non-pharmacologic measures
  • Remember: you can’t pump a dry well. Drugs primarily pump the well, salt and fluid fill the well.

Blood Pressure Restoration

A.   Increasing Central Volume

  • Salt loading (fill the well) may require 3 to 15 g per day
  • High pressure hose with abdominal binder
  • Elevate head of bed: microgravity signals kidneys to reduce total volume (less signal -> pee less at night)

B.    Tighten those vessels again!

  • Water drinking
  • Frequent small meals (both food and insulin are strong vasodilators)
  • Physical counter maneuvers
  • Physical exercise: water jogging, land exercise training, core building
  • Self-tilt exercises

Salt has 2 Actions

  • Short term: increases the volume of blood (need 96 fluid oz water)
  • Over the long haul: reduces nitric oxide synthase which dilates the blood vessels, a double negative that makes BP higher
  • Start with 1 gram twice per day, and go up or down based on response

Water Drinking

  • 8-16 oz water
  • Don’t include salt in it

Counter Maneuvers

  • Cross your legs
  • Sit w/legs crossed
  • Squat
  • “Party” pose

Exercise

  • Daily 10-minute minimum, 30 minutes is better
  • Interval training with 90 min cycle
  • Can start with water jogging if balance or endurance are major problems
  • Improves: mitochondrial function in the brain, motor coordination, baroreflex function, delays disease progression in Parkinson’s

Filed Under: Webinars - Announcements & Notes

  • Home

Categories

  • Monthly List – PD Webinars
  • Webinars – Announcements & Notes
  • Monthly List – Caregiving Webinars
  • Monthly List – Support Groups
  • Support Groups – Meetings & Notes
  • News
  • Research
  • Events
  • Exercise
  • Comment

Top Pages of the Stanford Parkinson’s Community Outreach Website

  • List of Live, Virtual PD Exercise Classes
  • List of PD Exercise Videos
  • Symptoms of PD
  • For Those Newly Diagnosed
  • Support Resources for PD

Featured Posts

Your top three Parkinson’s questions answered by the APDA

The American Parkinson Disease Association (APDA) recently shared the top three questions they are … [Read More...]

National Day of Action – Thursday, September 22, 2022

From the American Parkinson Disease Association, Northwest Chapter (APDA NW), Tuesday, September … [Read More...]

Archive

  • January 2023 (3)
  • December 2022 (7)
  • November 2022 (4)
  • October 2022 (9)
  • September 2022 (2)
  • August 2022 (3)
  • July 2022 (5)
  • June 2022 (6)
  • May 2022 (9)
  • April 2022 (5)
  • March 2022 (8)
  • February 2022 (5)
  • January 2022 (13)
  • December 2021 (7)
  • November 2021 (19)
  • October 2021 (14)
  • September 2021 (12)
  • August 2021 (9)
  • July 2021 (7)
  • June 2021 (10)
  • May 2021 (10)
  • April 2021 (16)
  • March 2021 (8)
  • February 2021 (27)
  • January 2021 (18)
  • December 2020 (18)
  • November 2020 (19)
  • October 2020 (13)
  • September 2020 (7)
  • August 2020 (12)
  • July 2020 (15)
  • June 2020 (13)
  • May 2020 (17)
  • April 2020 (14)
  • March 2020 (14)
  • February 2020 (5)
  • January 2020 (12)
  • December 2019 (10)
  • November 2019 (6)
  • October 2019 (6)
  • September 2019 (7)
  • August 2019 (5)
  • July 2019 (10)
  • June 2019 (3)
  • May 2019 (8)
  • April 2019 (10)
  • March 2019 (5)
  • February 2019 (9)
  • January 2019 (12)
  • December 2018 (2)
  • November 2018 (8)
  • October 2018 (10)
  • September 2018 (2)
  • August 2018 (7)
  • July 2018 (10)
  • June 2018 (9)
  • May 2018 (3)
  • April 2018 (10)
  • March 2018 (4)
  • February 2018 (8)
  • January 2018 (11)
  • December 2017 (11)
  • November 2017 (5)
  • October 2017 (11)
  • September 2017 (10)
  • August 2017 (7)
  • July 2017 (13)
  • June 2017 (10)
  • May 2017 (14)
  • April 2017 (12)
  • March 2017 (17)
  • February 2017 (11)
  • January 2017 (13)
  • December 2016 (4)
  • November 2016 (6)
  • October 2016 (1)
  • September 2016 (11)
  • August 2016 (5)
  • July 2016 (8)
  • June 2016 (4)
  • May 2016 (2)
  • April 2016 (2)
  • March 2016 (1)
  • February 2016 (1)
  • January 2016 (4)
  • December 2015 (1)
  • November 2015 (2)
  • October 2015 (3)
  • September 2015 (1)
  • August 2015 (3)
  • July 2015 (1)
  • June 2015 (1)
  • May 2015 (1)
  • April 2015 (2)
  • March 2015 (4)
  • February 2015 (2)
  • January 2015 (1)
  • December 2014 (1)
  • November 2014 (2)
  • October 2014 (1)
  • September 2014 (2)
  • August 2014 (2)
  • July 2014 (1)
  • June 2014 (5)
  • May 2014 (1)
  • April 2014 (2)
  • March 2014 (3)
  • February 2014 (1)
  • January 2014 (1)
  • December 2013 (1)
  • November 2013 (1)
  • October 2013 (1)
  • September 2013 (1)
  • August 2013 (1)