Drop in blood pressure in Parkinson's disease. What to do?

How to manage patients with orthostatic hypotension in the setting of Parkinson's disease. These recommendations apply to patients with multiple system atrophy and dementia with Lewy bodies.
Orthostatic hypotension is a condition in which blood pressure drops when a person stands up, and it fails to return to the normal level quickly. This form of low blood pressure is quite common in patients with Parkinson's disease, MSA, and lewy body dementia. It occurs less frequently in the early stages of the disease but becomes more prevalent as the disease progresses.
Blood pressure readings have two numbers- the systolic and diastolic numbers. The systolic number represents the highest pressure when the heart beats and pumps blood through the body, while the diastolic number represents the lowest pressure when the heart relaxes between beats. Orthostatic hypotension is said to occur when there is a drop in the systolic number by at least 20 mmHg or in the diastolic number by at least 10 mmHg within 3 minutes after standing.
Symptoms of orthostatic hypotension include light-headedness, dizziness, weakness, fatigue, nausea, blurred vision, mental slowing, legs buckling, and neck pain radiating to the shoulders (also known as coat-hanger pain). The condition can lead to falls and fainting, which can be dangerous.
Orthostatic hypotension may be more common in the early morning, hot weather, after a meal, after drinking alcohol, when urinating or having a bowel movement.
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