October 30, 2014

Progress on the Ups and Downs of My NOH Blood Pressure

I thought I'd settled my decades-long problem with high blood pressure (BP) when I got my doctor's approval to quit the meds. Many authorities now say that people 80+ with no history of cardiac issues probably don't need BP pills. I gleefully reported this development in an April post.

I kept checking my numbers at home with my wrist monitor, because my favorite pill -- 5-HTP -- can cause a sudden increase in BP if I take too much of it. I was pleased to see that my normal readings did not exceed the adjusted 150/90 guideline for people 60 and older.

My recent medical history has resembled the whack-a-mole game -- I resolve one problem and a new one pops up. Here's latest example.

Sudden Drops In Blood Pressure
For several years, I've experienced occasional sinking spells -- feeling lightheaded and close to fainting. These incidents initially happened only on hot summer days when I was outside. I soon discovered that big drops in my systolic BP -- sometimes below 90 -- accompanied these incidents. 

In the past six months, these episodes have occurred much more frequently and at unpredictable times. One of my PD support group members recently talked about his fears of falling when he had similar sinking spells. His neurologist recommended eating salted pretzels to counteract those BP drops.

I found this info on the internet:
  • Levodopa, the primary medication used to treat Parkinson's, can lead to BP drops.
  • People with PD often experience orthostatic hypotension (OH), a type of low blood pressure that people -- especially seniors -- experience when they rise from a chair. While the symptoms were just like mine, that specific cause didn't apply in my case. My BP drops occurred randomly and unpredictably.
  • With more research, I found a subset of OH called neurogenic orthostatic hypotension (NOH), which occurs only with people with Parkinson's or other neurological diseases.
Sudden Spikes in Blood Pressure
It's not just BP drops. I've also experienced occasional BP spikes. Unlike the pressure drops, the spikes followed a pattern -- occurring at the end of each three-hour pill cycle, as one set of pills was wearing off and the next set of pills hadn't yet kicked in.

I've been taking two regular carbidopa/levodopa (25/100mg) every three hours. That's 16 pills a day, and 1600mg of levodopa, the active ingredient! Five years ago, I started with three pills a day!

Treatment of  Both High and Low Blood Pressure In Not Easy
I've been working with my neurologist and my blood pressure specialist on this problem.

Being anti-pill, I first focused on the levodopa, blamed it for everything, and argued that I needed to get off this frigging pill. But my neurologist zeroed in on the cycle of levodopa's effectiveness. He thought we could reduce the number and severity of BP spikes if we could smooth out the levodopa delivery. Guess who was right? Yep, my neurologist. Guess what his solution was? Yep, more pills.

Instead of two regular carbidoba/levodopa pills eight times a day, I'm now taking one regular and one extended release pill, which delivers 200mg of levodopa -- not the regular 100mg. This new regimen adds 800mg of levodopa daily... for a total 2400mg every day.

Meanwhile, my BP doctor has prescribed two new medications. Just what I needed... more pills!
  • Midodrine 2.5mg (lowest dosage) three times a day. This med is used to treat low BP. Directions suggest taking it upon arising, before breakfast, and at mid-afternoon. No midodrine should be taken after 3pm, since it might cause supine hypertension (high blood pressure as a result of lying down).
  • Nifedipine 10mg (lowest dosage) as needed. Nifedipine is a calcium channel blocker used to treat  temporary high BP and to control angina (chest pains). I take it only when I have a serious BP spike. It certainly works, lowering my systolic pressure by 30+ points within half an hour. Only one problem: it often keeps on working and drives me into hypotension (low blood pressure). 
The best solution so far? Drinking several glasses of cold water when I see the upper number dip below 100. There's another almost surefire remedy: ingesting salt, which I find unpleasant. 

I've got a new top-of-the-line abdominal binder, highly recommended for treating low BP. I'm supposed to wear this girdle during all waking hours. But now that the BP drops are less frequent, I'm holding off climbing into the corset. But I'll talk to the doctor about this shortly.

So... these treatments of BP drops and spikes represent "progress, but not perfection."

My biggest problem is managing these treatments when I'm away from home. I can now usually sense when a BP episode is imminent, and I usually know whether it'll be a spike or a drop. But not always. A few weeks ago, I guessed wrong and ended up in the hospital emergency room after taking nifedipine for what turned out to be a low -- not high -- BP episode.

I try to remember to take my backpack -- containing my BP wrist monitor -- whenever I leave the house for more than a few minutes. Sometimes I forget to take it. Other times, I forget I have it with me, and leave it behind at one of the stops on my travels.

Not Good News: Orthostatic Hypotension Strongly Predicts Parkinson's Dementia
Researchers at McGill University identified several non-motor features of Parkinson's that often predict dementia -- orthostatic hypotension, impaired color vision, and REM sleep disorder.

For more than four years, the researchers observed 80 Parkinson's patients. From that group, 27 developed dementia.

Othostatic hypotension was an especially strong predictor. Each 10mmHg drop in systolic BP was associated with a 1.84 increased likelihood of developing dementia. Patients with a drop greater than 10mmHg carried a 7.30 increased risk.

1 comment:

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