Blood pressure problems are a common problem in patients with Parkinson’s disease and multiple system atrophy, with the latter usually manifesting more severely and appearing earlier, greatly affecting the patient’s quality of life. What blood pressure problems can occur in patients with Parkinson’s disease? 1. Postural hypotension Postural hypotension is defined as a lower blood pressure in the standing position than in the recumbent position, with a decrease in systolic blood pressure >= 20 mmHg or diastolic blood pressure >= 10 mmHg. In patients with multiple system atrophy, the decrease is generally >= 30 mmHg or 15 mmHg. Postural hypotension is one of the most likely causes of decreased quality of life and mobility. In mild cases, it manifests as dizziness in the standing position and a feeling of heaviness in the neck and shoulders, and in severe cases it can lead to syncope and cause secondary injuries such as fractures. Some data show that about 40-60% of patients with Parkinson’s disease have postural blood pressure, but only 20% have symptoms. A much higher percentage of patients with multiple system atrophy have postural hypotension than in Parkinson’s disease, and most are symptomatic, with syncope common. The cause of the occurrence of postural hypotension is mainly related to the pathophysiological damage of the disease itself, but anti-Parkinsonian drugs have the potential to exacerbate this change. 2. Recumbent hypertension In addition to postural hypotension, patients may also exhibit elevated blood pressure in the recumbent position, exceeding the upper limit of normal values (140/90 mmHg) and even up to about 200 mmHg, becoming a hidden risk for cardiovascular events. Postural hypotension tends to occur in the morning and after meals, and hypertension tends to occur when lying down, especially at night and in the early morning. How can people with Parkinson’s disease cope with postural hypotension? Non-pharmacologic treatments – are often very effective in improving postural hypotension and deserve attention. Specific measures include: (1) Review all oral medications and discontinue medications with side effects of postural hypotension if possible; (2) Take care to ensure water and salt intake. 400-500 ml of water early in the morning is very effective and has a rapid onset of action, lasting 60-90 minutes; (3) Avoid environments that may lead to fluid loss or vasodilation, such as hot baths, excessive ambient temperatures, (4) Use of compression stockings during the day; (5) Actions to increase blood return, such as abdominal compression, tensing the calves (tensing the feet), etc.; (6) To reduce the risk of falling, it is advisable to follow a slow, step-by-step movement from lying to sitting to standing when rising. Medication – Available medications include fludrocortisone acetate and midodrine, which have limited effects and corresponding side effects and need to be taken under medical supervision. Midodrine is relatively commonly used, and the appropriate time to take it is early in the morning before waking up and before lunch, and avoid taking it four hours before bedtime. Chinese medicine is often a good adjunct to the treatment of postural hypotension.