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annehnw

Widely Fluctuating Blood Pressure

8 posts in this topic

My husband has had Parkinson since 2003. His blood pressure has been widely fluctuating from 130/90 during sleep to 70/50 during waking up in the morning. He is taking Sinemet 100/250. We are thinking about changing to Rytary and wonder if anyone has experienced less fluctuating blood pressure when switching Sinemet short acting to Rytary?

Dear Dr Okun, would you please advise of your experience with Rytary regarding Blood pressure less fluctuating than Sinemet short acting?

Thank you in advance

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Rytary won't magically fix this issue.  The Parkinson and the dopamine replacement will together push the blood pressure down.  The trick is to avoid wearing off and find medication intervals that work to avoid fluctuations and sometimes adding night-time doses.  In cases where dizziness or orthostasis or passing out becomes an issue then consider adding hydration, compression stockings, and sometimes medications to increase blood pressure.

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Dear Dr Okun, 

Thank you so much for your time and your insightful advice as always.

My husband is currently taking Sinemet 25/100 ( not 100/250 previously typo error) as 1.5-1-1.5-1-1.5-1 (last daily dose is 1 Sinemet at bedtime around 12am) 

He is also taking Ropinirole ER 8mg at 9am. The regimen seems to control his Parkinson shaking.

We have Home blood pressure readings from getting up until bedtime around 12 am but unable to get blood pressure readings during his sleep.

Would you advise using 24 hours ambulatory blood pressure monitoring to get readings during sleep for Parkinson ? Is the machine still accurate in Parkinson patients?

 

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We generally do not wake our patients to get BP readings during sleep.

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Dear Dr Okun,

Thank you for your advice somehow I did not get the notice of your response at all.

My husband had 24 hours Blood pressure monitor done  at home.

The readings confirm that he has high blood pressure (range 150s/high 90s) during sleep and low blood pressure as low as 92/43 during waking. Lowest blood pressure readings are in the morning after getting up then slowly rising and around 5-6 pm, his blood pressure readings are within 110s/ high 70s. 

His MD specialist explains that this pattern of blood pressure is due to Parkinson diminishing autonomic function.

We mention to both his internist and his MD specialist  that he will  compression stockings (15-20 mmHg) for awake low BP.

However we are undecided if to try  a short acting medication to lower high BP readings during sleep as his doctors say the medication may lower his waking low BP further.

He has sleep apnea (moderate) but unable to use CPAP machine.

He took 1 Sinemet 25/100 at bed time around 12am so his BP readings seem to be ok until about 3pm until getting up around 7:30-8am.

His cholesterol, weight are good and he walks at least 30 minutes daily since diagnosed with Parkinson in 2013. He has osteoporosis, DEXA done 2016 is lowest at  hip = 3.2 . He checks his blood pressure daily before leaving for his walk and if below 90/60, he drinks 1-2 glasses of water.

Would you recommend to start a medication to lower his high blood pressure during sleep? Which medication do you prescribe in your practice for elevated blood pressure during sleep ?

Thank you for your time and insightful advice

 

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In general 150's systolic during sleep I generally do not treat.  Some people will add extra doses of levodopa at night when people awaken to go to the bathroom.  Levodopa will reduce BP and also the PD autonomic issues are worsened just from disease progression.

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Dear Dr Okun,

Thank you so much for your clearly stated advice.

I happen to come across an article regarding the  panel discussion about Blood pressure in Parkinson. The panel includes NPF in Miami, Florida. The article can be found at this web  linkk

https://link.springer.com/article/10.1007%2Fs00415-016-8375-x

I do not see your name on the article,  are you advising the panel? The panel's recommendations concur with your advice.

My husband's BP highest  in the range 150 /90 during sleep only between 3am-waking up (6:30-8am) are in the 150 range.  He took Sinemet 25/100 at bedtime usually 12:30-1am.

Would Rytary taken at bedtime lowers his  high blood pressure longer ( assumed less potency)  than his current short acting Sinemet 25/100?

 

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I can't speak for the panel, but of course most panels sponsored by a major foundation provide excellent tips that can be taken to your doc for local advice....

In some people your proposed strategy may work, but in others likely not....

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