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During our Annual MSA Support Group Patient/Caregiver Conference in September 2012, it was apparent that a decent number of patients were suffering from low blood pressure symptoms, but had not been diagnosed or treated for the condition. We also frequently hear stories about MSA patients suffering for a few years from lightheadedness and other symptoms before their doctors find the cause.

Do you have the symptoms of low blood pressure when you stand?

Symptoms of low blood pressure can range in severity, from mild lightheadedness after standing to fainting and blacking out. Symptoms can include any combination of dizziness, lightheadedness, blurry vision, head and neck pain, trouble concentrating, feeling faint, blacking out, fainting and frequent falls. Especially because of fainting and falls, symptomatic low blood pressure can lead to injury and disability

Low blood pressure symptoms are often the cause of early disability in multiple system atrophy (MSA) patients. Low blood pressure upon standing, known medically as orthostatic (standing) hypotension (low blood pressure), is a characteristic early sign of MSA. Approximately 80% of MSA patients have orthostatic hypotension (OH). If the low blood pressure is caused by MSA or other neurological disorders it is called neurogenic orthostatic hypotension. However, orthostatic hypotension can also be caused by certain medications, dehydration, and heart problems and these causes need to be ruled out.

If You Have Low Blood Pressure Symptoms

If you feel low blood pressure symptoms you should speak with your doctor and ask to have your blood pressure checked not only while lying down, but also after sitting and then at one and three minutes after standing. If you have a greater than 20 mmHG (millimeters of mercury) drop in systolic blood pressure during the standing test you have orthostatic hypotension and you should discuss treatment options with your physician.

Treatments for Orthostatic Hypotension

Before prescribing a medicine your doctor may recommend life-style modifications, such as:

  • Increasing the amount of water you drink
  • Adding salt to your diet
  • Sleeping with the head of your bed elevated
  • Wearing compression stockings
  • Exercise or physical counter-maneuvers
  • Staying inside on hot days

If life-style modifications do not work or have limited effect, there are two FDA approved treatment for orthostatic hypotension – midodrine and newly approved Northera (droxidopa). There are also other medications that doctors prescribe to help control low blood pressure symptoms that are not indicated for OH.