Low blood pressure

Find out more about low blood pressure in Parkinson’s, including postural hypotension, and how to manage it.

Key points

Postural hypotension is a type of low blood pressure that’s common in Parkinson’s. It can cause your blood pressure to drop when you stand up. This can make you feel faint and can increase the risk of falls.
Your doctor, Parkinson’s nurse or a pharmacist can check your blood pressure, and show you how to check it yourself at home. The general pattern of your blood pressure checks is more important than individual results.
Changing position, gentle exercises, drinking cold water and eating small, frequent meals may help you manage low blood pressure symptoms.
If self-help measures aren’t enough, medication may be an option.

Blood pressure goes up and down naturally during the day. It changes depending on how active you are, and how you’re feeling. If you’re active, such as when you’re doing physical activity, your blood pressure will rise. If you’re resting and feeling calm, or you’re asleep, it will go down.

Low blood pressure is called hypotension. High blood pressure is called hypertension.

How blood pressure is controlled

Your brain, nerves and spinal cord (called the autonomic system) control your blood pressure. This process involves sensors (baroreceptors) in your neck, which send your brain signals about your blood pressure. The brain tells your heart and blood vessels when to increase or decrease your blood pressure.

The autonomic nervous system sends blood to where it is needed most.

For example, during physical activity, your blood pressure increases so your muscles get more oxygen. After you eat, more blood goes to your stomach to help you digest food, reducing blood pressure elsewhere.

Checking blood pressure

Different healthcare professionals can check your blood pressure, including your doctor, nurse or a pharmacist.

Check if you could be eligible for a free blood pressure check on the NHS website.

You can check your blood pressure yourself at home too. Speak to your doctor or nurse about how to do this and they will explain what equipment you may need.

Measuring blood pressure

Your healthcare professional will listen to your pulse, usually in your upper arm, and take 2 blood pressure readings.

To do this, they will wrap a cuff, connected to a blood pressure monitoring machine, around your upper arm. They’ll inflate the cuff with air for a few seconds to put pressure on your blood vessels.

Some professionals may listen to your pulse with a stethoscope.

Blood pressure check results (readings)

A blood pressure reading is made up of 2 numbers. The first reading is the highest pressure when your heart pumps blood around your body. This is systolic pressure.

The second reading is the pressure when your heart is resting between beats. This is diastolic pressure.

Blood pressure is measured in mmHg, which means millimetres of mercury.

If your systolic pressure is 120mmHg and your diastolic pressure is 70mmHg, your blood pressure is written as 120/70 (or 120 over 70).

After your first blood pressure check in a clinic, your healthcare professional may recommend that you take your own readings at home over the next few days.

Is my blood pressure reading normal?

A blood pressure reading between 90/60 and 120/80 is ideal.

Readings lower or higher than this are classed as low or high. However, blood pressure readings up to 140/90 are very common, and don’t usually need to be treated with medication for high blood pressure.

Natural changes to blood pressure during the day

Blood pressure naturally changes over the day. If you feel well, a single blood pressure reading which is higher or lower than you were expecting is nothing to worry about.

Also, sometimes the blood pressure machine has to adjust to your arm. So healthcare professionals will often take a second reading a minute after the first.

For these reasons, it’s better to look at the overall pattern of several blood pressure results. You should ideally take the readings at the same time of the day, whether every day or weekly.

If you have symptoms of low blood pressure, such as light-headedness, dizziness or feeling faint, speak to your GP, specialist or Parkinson's nurse.

High blood pressure symptoms

If you have a high blood pressure reading and symptoms of high blood pressure, call NHS 111 for advice.

High blood pressure symptoms include:

headaches
chest pain that comes and goes
seeing flashing lights or having blurred vision.

Call 999 if you have:

sudden chest pain that does not go away
pain that spreads to either arm, or your neck, jaw, stomach or back
chest pain and you feel sweaty, sick or short or breath.

These could be signs of a heart attack.

What is low blood pressure?

Low blood pressure is either less than 90mmHG systolic, or less than 60mmHg diastolic (which will be written as 90/60mmHg or less).

Causes of low blood pressure

Several things can cause low blood pressure, including:

Parkinson’s,
diabetes
some medications, including drugs taken for prostate problems.

Parkinson’s affects the autonomic nervous system, which controls blood pressure. Low blood pressure in Parkinson’s can also be linked to Parkinson’s medication.

Low blood pressure is more likely as we get older.

Low blood pressure symptoms

Common symptoms include:

feeling dizzy or light-headed when you stand up
weakness (often a feeling of weak legs)
confusion
blurring of vision
neck and shoulder pain (sometimes called "coat hanger syndrome").

Many people have low blood pressure but don’t have symptoms. If you don't have symptoms and feel well, and your healthcare professionals are not worried, then low blood pressure is not a problem in itself.

Low blood pressure and fainting

If low blood pressure leads to less blood getting to your brain, you may feel light-headed or faint. Fainting could cause you to fall and hurt yourself.

Feeling faint may feel unpleasant and can cause mild confusion. Confusion should go away when your blood pressure goes back to normal.

If you feel dizzy or that you might faint, sit with your legs raised or lie down until the feeling passes.

Fainting can happen suddenly. Before fainting, you may feel:

dizzy
sick
warm or hot.

You may notice your skin feeling cold or sweaty, or changes to your vision.

If you faint, you will usually wake up very quickly.

After fainting, it’s important to:

stay lying down. This allows blood to reach your brain and help you feel better. You can then sit up slowly.
gently pump your feet or cycle your legs. If you feel able, this may help to get your blood moving.
drink a glass of cold water. This can help increase your blood pressure.

Situations that can trigger low blood pressure symptoms

Low blood pressure symptoms are most likely to happen when there is an increased need for blood around your body, but your body can’t respond quickly enough.

This includes:

when you stand up. Low blood pressure symptoms after you stand up, particularly from lying down, is called postural hypotension. It is common in Parkinson’s.
after a meal. Digesting your food takes blood from other parts of your body, which can lower blood pressure.
when you are dehydrated. Dehydration can be caused by vomiting, overheating, not drinking enough or an infection. Not getting enough fluids in your body makes it harder for your autonomic nervous system to control your blood pressure.
after drinking alcohol. Alcohol causes blood vessels to become wider (dilate), which can lower blood pressure. Alcohol can cause dehydration too.
being in a hot environment. For example, a heated room or a hot bath. Blood vessels, particularly those close to the skin, become larger as a way of cooling the blood down. This reduces your blood pressure.

You may notice symptoms:

in the morning. Your blood pressure is usually lower while you are asleep, so may be low when you wake up.
when you’re anxious. Anxiety can cause you to breathe too much (hyperventilation), which lowers your blood pressure.

Multiple systems atrophy (MSA)

Although MSA is rare, low blood pressure symptoms are common for people with this kind of parkinsonism. This is because MSA damages your autonomic nervous system.

What happens in postural hypotension?

When you stand up, your heart rate should increase and blood vessels should squeeze to move blood around your body.

But in postural hypotension, this doesn’t happen and blood pools in your legs. This means less blood returns to your heart and brain. This can cause dizziness or fainting.

Postural hypotension symptoms

Postural hypotension symptoms are similar to the symptoms of low blood pressure generally.

The difference is what triggers the symptoms: changing position from lying or sitting down to standing up.

When standing up, you may feel:

short of breath
tired or fatigued
pain in your lower back.

This makes postural hypotension a common cause of falls in Parkinson’s.

Causes of postural hypotension

Parkinson’s

Postural hypotension can be caused by the way Parkinson’s damages the nerves that help your heart and blood vessels to work.

A side effect of medication

Examples include:

Parkinson’s drugs, particularly levodopa and some dopamine agonists
drugs which help reduce swelling in your feet and ankles (diuretics)
some antidepressants
drugs to treat high blood pressure (anti-hypertensives).

It is very important to take your medication as prescribed. Don’t stop taking your medication suddenly, because this can be dangerous. If you are worried about side effects, speak to your specialist or Parkinson’s nurse about changing your medication. Your doctor may not recommend changing your drugs if they help with your other symptoms.

Your specialist may choose to increase your Parkinson's medication slowly if they are concerned that it might impact your blood pressure. This allows them to see if your blood pressure is affected.

Blood pressure issues can be difficult to manage, but your healthcare team is there to support you. They will give you self-help tips and treatment options based on your symptoms and preferences.

Checking for postural hypotension

If you have low blood pressure symptoms, your healthcare professional will:

Ask you to lie down for five minutes.
Check your blood pressure.
Ask you to stand up and then re-check your blood pressure after one and three minutes.

You should let them know if you feel any symptoms when you stand up.

You can ask your healthcare professional to explain how to check for postural hypotension at home. If you own a blood pressure monitor, it can be useful to check your blood pressure when both sitting and standing.

You can then look for any differences between the readings. If you see a big difference between readings, tell your GP, specialist or Parkinson's nurse.

Supine hypertension

Supine means lying flat on your back. Some people with Parkinson’s who have postural hypotension also have a type of high blood pressure called supine hypertension.

This may happen because of the way Parkinson’s damages nerves in the body.

Supine hypertension often causes no symptoms. However, it is important for your healthcare professional to check for it, as in some cases it will require treatment.

Your doctor can tell you more about supine hypertension and how to manage it. Clinical guidelines say that if you have, or your doctor thinks you might have, postural hypotension, they should check to see if your blood pressure is high when you’re lying down (supine).

To reduce your blood pressure when you’re lying down, the following may help:

Avoid lying down during the day.
Sleep with your head elevated to reduce blood pressure. A pillow could help.
Have a small snack before bed. Digesting your food can help lower your blood pressure.

In severe cases, your doctor may prescribe medication, taken before you go to bed, to temporarily lower your blood pressure.

If your doctor diagnoses you with supine hypertension, it doesn’t necessarily mean that you will need to change or stop any treatment for low blood pressure. Always follow your doctor’s advice about how to take your medication.

Managing low blood pressure symptoms

Things to try yourself

There are lots of things you can do to manage low blood pressure symptoms, and the symptoms of postural hypotension.

When changing position, It may help to:

take your time. This may help you avoid dizzy spells, such as when getting up from a chair or up from bed, especially if you have been asleep. When you are out of your chair or bed, stand still until you feel steady but try not to stand still for long periods.
try gentle exercises. If you have been in one position for a while, you could try pumping your feet up and down 10 times to prepare your body for moving.

It may be helpful to:

do tasks such as getting dressed sitting down and in stages. If you are doing something that means you have to stand, such as ironing, move about a little.
shower while sitting down. Your Parkinson’s nurse can advise you where to buy a purpose-made shower chair. For men, it may help to sit down to go to the toilet when you can.
sit for a moment before you get out of bed.

If you go into hospital, make sure you or someone close to you tells the hospital staff about your low blood pressure symptoms, so they can help you manage them during your stay.

Try to avoid:

sitting in the sun or a hot place for too long. If you feel too hot, use a fan or a cold flannel to cool yourself down and drink plenty of fluids. Wearing a sun hat can help too.
exercising when it’s too hot.

Your Parkinson’s nurse or an occupational therapist can give you advice on how to cool your house in summer.

Other tips to try

Bending or reaching for things slowly

Hold on to something as you change position if you need to. This will stop you losing your balance and falling over. Try to have important things within easy reach if possible. An occupational therapist can help you practise movements like these and suggest ways of arranging items in your home to make things easier.

Gentle exercises to raise your blood pressure

You could try:

bending forwards and backwards from your hips to loosen up your body before you stand up. This may make it easier to stand up and help you keep your breath, so you don’t feel dizzy
squeezing your hands into a fist
gentle marching movements on the spot
crossing and uncrossing your legs.

Exercises like these may help prevent dizziness, so try them before you stand up. If you feel dizzy, it’s best to sit still and let the dizziness pass. Then you can try the exercises to help improve your blood flow.

Talk to a physiotherapist for guidance on exercises.

Full-length support stockings

These can encourage circulation. They are available as tights or long stockings, either on prescription or over the counter. Your local pharmacist may sell them or be able to tell you where you can get them.

Abdominal binders

Abdominal binders, worn to help prevent low blood pressure, can be effective for some people. Some find that they can weaken their back muscles, and can be difficult to put on. They can also be stuffy in hot weather.

Shooting sticks

Shooting sticks are walking sticks that can turn into a seat. Some people find them helpful if they feel faint or dizzy when walking. You can find them in sports shops or online. They can be heavy, but you can buy a strap to carry your stick on your back when you’re out walking. Speak to your Parkinson’s nurse or a physiotherapist for advice about using a shooting stick.

Food and drink and low blood pressure symptoms

Drinking water before you get up in the morning can help to reduce symptoms of low blood pressure, especially if the water is cold.

If you tend to feel dizzy after a meal, try to do the following after you eat:

Lie or sit down.
Drink 2 glasses of water.

Drinking more water generally might help too. We should all aim to drink around 3 to 4 pints (1.5 to 2 litres) of fluid per day, unless your healthcare team has told you something different.

It may also help to:

take certain medications with food. Taking some medication on an empty stomach may make low blood pressure symptoms worse, as we absorb medication more quickly than usual if our stomachs are empty. Always follow your doctor’s advice on how to take your medication and speak to them before making any changes.
eat small meals. When you eat, blood goes to your stomach and intestines from other parts of your body to help digest the food. So keeping your meals small and frequent may help reduce your symptoms.
drink less alcohol. It’s also important to keep hydrated by having non-alcoholic drinks between, or instead of, alcoholic drinks.

Medication to treat postural hypotension

If postural hypotension continues to cause you problems after you’ve tried these practical tips, your GP or specialist may prescribe medication to help you manage it.

This may include:

ephedrine
midodrine
fludrocortisone.

However, these medications can affect how well some Parkinson’s drugs work. Your doctor can advise you on whether medication is the right choice for you.

If you have been taking medication for high blood pressure, make sure your blood pressure is checked regularly. Medication to lower blood pressure, combined with the drugs used for Parkinson’s, may make your blood pressure too low. Your doctor can tell you more about this.

Driving and low blood pressure

Having low blood pressure that causes symptoms, like dizziness, could affect your ability to drive safely.

If you drive in England, Scotland or Wales, it’s a legal requirement to tell the DVLA if you have any medical condition that affects your ability to drive. This could include low (or high) blood pressure. If you drive in Northern Ireland, you must tell the DVA.

It’s also a legal requirement to tell the DVLA or DVA that you have Parkinson’s when you’re diagnosed.

Speak to your GP, specialist or Parkinson’s nurse if you’re worried about Parkinson’s or low blood pressure and driving.

Driving and medication

It’s illegal to drive if your ability to drive is affected by any medication that you’re taking.

Read our information on driving and Parkinson’s.

Our helpline and other useful contacts

Our helpline

Call our helpline free on 0808 800 0303 for advice on blood pressure issues or any aspect of living with Parkinson's.

More information and support

The British Heart Foundation provides information and a helpline on heart and circulatory issues, including low blood pressure. Visit the British Heart Foundation website.

Driving licensing contacts

Find contact details for the Driver and Vehicle Licensing Agency (DVLA) (England, Scotland, Wales) on the GOV.UK website.

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