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Orthostatic Hypotension in Parkinson’s Raises Long-Term Fall Risk

Parkinson's Foundation Science News blogs

Orthostatic hypotension (OH) — a significant drop in blood pressure that occurs when you stand up — is one of the most common non-movement symptoms of Parkinson’s disease (PD). It can cause dizziness, blurred vision, fatigue, and difficulty thinking, which can lead to falls. Generally, OH is also associated with cardiovascular problems (issues with the heart). Together, these risks highlight the importance of understanding how OH impacts health outcomes, especially in people with Parkinson’s.

A new nationwide study, published in Parkinsonism & Related Disorders, explores the longer-term consequences for people with Parkinson’s who experience OH. The study was led by Hikaru Kamo, MD, PhD, a 2025 Melvin Yahr Parkinson’s Disease Clinical Research Award recipient. Dr. Kamo and his research team, based at the University of Florida’s Norman Fixel Institute for Neurological Diseases, also included collaborators from the Parkinson’s Foundation.

Study Results

Using a nationwide insurance claims database, the research team analyzed records from 111,368 adults with Parkinson's disease, of whom 2,598 had a documented diagnosis of OH. After using statistical methods to account for differences between the two groups — such as age, other medical conditions and medications — the team found that people with Parkinson's and OH had a 35% higher chance of experiencing a fall over five years compared to those with Parkinson's alone. They also accumulated more total falls over time.

However, despite long-standing concerns that OH might put extra strain on the heart and blood vessels, the study found no significant link between OH and major cardiovascular events such as heart attack or stroke.

Among those with OH who were taking commonly prescribed medications for the condition, such as midodrine or fludrocortisone, fall risk was 34% higher compared to those not on these drugs, with no added cardiovascular benefit.

However, the study authors suggest that the most likely explanation is that people with more severe OH symptoms are more likely to be prescribed medication for the condition, and as a result are more likely to experience falls regardless of medication use. At this point, it should not be considered a cause-and-effect relationship until additional studies investigate further.

Overall, these findings were consistent across analyses, suggesting that OH in Parkinson's is more likely to lead to problems with falls compared to cardiovascular issues. Therefore, treatment for OH in Parkinson’s should place a strong emphasis on fall prevention.

Highlights

  • People with Parkinson's and OH had a 35% higher chance of experiencing a fall over five years compared to those with Parkinson's alone. They also accumulated more total falls over time.
  • Despite concerns that OH might strain the heart and blood vessels, the study found no significant link between OH and major cardiovascular events such as heart attack and stroke.
  • Among those with OH, people taking common OH medications (such as midodrine or fludrocortisone) had a 34% higher fall risk compared to those not on these drugs, without any added cardiovascular benefit.
  • In people with Parkinson’s and OH, fall risk is the main safety concern compared to cardiovascular events.

What does this mean?

This study supports that orthostatic hypotension in Parkinson’s is more of a fall-risk issue instead of a cardiovascular one. While that is reassuring news on the heart-health side, it underscores the importance of addressing fall prevention as a top priority for people living with Parkinson's and OH.

This research also indicates that more studies are needed on the impact of OH medications. Current research suggests that OH medications primarily treat the symptoms of OH, rather than treating the underlying cause of the condition. While these results of this study show that fall risk is higher in people with Parkinson’s taking OH medication compared to those without medication, the authors suggest that this may be a misleading association. To determine a cause-and-effect relationship, further studies on this topic are needed.

How do these findings impact people with Parkinson’s right now?

Overall, the message to the Parkinson’s community is that OH should be viewed primarily as a mobility and safety issue rather than a heart problem. This study adds important evidence about the real-world impact of OH in Parkinson’s and points to the need for better fall-prevention strategies and further study of treatment approaches.

PD care should prioritize fall prevention strategies, regardless of OH status. For people with PD and care partners, this means greater emphasis on lifestyle approaches such as fall-prevention programs, physical therapy, balance training, home safety modifications and knowing if medications can increase fall risk.

If you experience OH symptoms — such as weakness, difficulty thinking, headaches and blurred or dimmed vision — discuss them with your doctor.

Learn More

The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about PD and orthostatic hypotension through our resources below, or by calling our free Helpline at 1-800-4PD-INFO (1-800-473-4636) for answers to your Parkinson’s questions.

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