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.

• Fall Prevention in Parkinson’s
• Vertigo, Dizziness & Low Blood Pressure
• Podcast: Understanding Neurogenic Orthostatic Hypotension

As a movement disorders specialist, one issue that people with Parkinson’s disease (PD) often bring up to Sneha Mantri, MD, during office visits is stigma. Stigma stems from stereotypes and lack of understanding that can lead to judgment, delayed diagnosis, isolation and feelings of shame for people with Parkinson’s and chronic diseases.

In our latest Neuro Talk, Dr. Mantri, Chief Medical Officer of the Parkinson’s Foundation, highlights the stigma that can accompany living with Parkinson’s and how it is being researched. Dr. Mantri and the Parkinson’s Foundation believe that combatting stigma through education, storytelling and awareness efforts can help the greater PD community. Dr. Mantri highlights what stigma looks like for people with PD, research findings surrounding stigma and ways to combat it.

What is stigma?  

Stigma is when a person or group is judged or treated unfairly because of a negative belief or stereotype about them. Stigma is associated with stereotypes, prejudice, discrimination and exclusion. Experiencing stigma can significantly impact the lives of people living with Parkinson’s and care partners.

What does stigma look like for people with Parkinson’s?

Stigma around Parkinson’s often begins with misunderstanding. Stereotypes ignore the reality that people of all backgrounds — men and women — live with PD. Visible symptoms like tremors, freezing of gait or speech issues can be misread as intoxication or aging, rather than signs of a complex neurological condition. These reactions can be hurtful and isolating.

Many people with Parkinson’s internalize stigma, leading to delaying treatment, hiding symptoms or their diagnosis out of embarrassment or shame. In the workplace, stigma can fuel fear of being seen as less capable (learn more about employment with Parkinson’s). It can also show up as fear of becoming a burden to loved ones. Acknowledging these experiences is a critical step toward breaking down stigma.

Research Findings Surrounding PD and stigma

Stigma worsens quality of life for people with Parkinson’s. Researching stigma is critical, as bringing academic attention to the topic is critical to addressing it. Research has found that stigma:

• Shapes the PD experience.
• Contributes to social anxiety, isolation, hesitation to seek medical care, loneliness and emotional distress.
• Misconceptions and bias lead to people with Parkinson’s being stereotyped, devalued or even avoided. This, and worsening symptoms over time, can lead to self-stigma, impacting self-esteem and depression.
• Many people with Parkinson’s have experienced a form of stigma.
• Stigma can take many forms. Felt stigma is when someone believes others see them negatively.
• Care partners may experience affiliated stigma, facing bias because they are connected to a person with Parkinson’s.

For doctors and healthcare professionals, understanding stigma’s impact can help them respond with greater empathy and more proactive care strategies. This is crucial people with Parkinson’s and care partners, who often experience their own forms of stress and social isolation.

Ways to Combat Stigma

One of the most powerful ways to reduce stigma is through education and staying connected. The Parkinson’s Foundation works to share information about Parkinson’s to help spread awareness and knowledge, breaking down the misconceptions that fuel stigma. Explore Parkinson’s Foundation resources now.

“As a movement disorders specialist, I talk to patients about stigma. Research shows that practicing narrative medicine — using a patient’s story to guide care — helps their care team address the issues that matter most to them. This approach can strengthen independence and reduce stigma.” – Dr. Mantri

Personal stories (including My PD Stories), humanize Parkinson’s and highlight resilience. While community engagement — through events like Moving Day, support groups or exercise classes — helps people feel less alone and build connection.

Everyone can play a role in reducing stigma by knowing the signs of Parkinson’s, volunteering or sharing information to raise awareness.

Watch Dr. Sneha’s latest Neuro Talk and catch up on past topics at Parkinson.org/NeuroTalk.

Hola, mi nombre es Coran Rivera y soy Promotora de Salud. Actualmente, soy Embajadora de la Parkinson’s Foundation. 

Tengo aproximadamente 8 años trabajando en la comunidad de Chicago y suburbios ofreciendo clases y recursos de salud en la comunidad de la 3ra edad latina.

Mi experiencia laboral me ha llevado a educar, ayudar y convivir con personas de la tercera edad y a romper las barreras del idioma, entre otros determinantes sociales en la salud.

Trabajé en una agencia que ayudaba en la lucha contra el Alzheimer y así es como conocí la Parkinson’s Foundation ya que, al ser tipos de demencia, están relacionadas con las funciones del cerebro que afectan a personas de la tercera edad.

Actualmente, estoy tomando entrenamientos sobre el Parkinson y llevando los recursos a las comunidades latinas y de bajos recursos para romper estigmas de la enfermedad y dando a conocer los avances de la lucha contra el Parkinson.

He podido conocer y convivir con personas que actualmente tienen Parkinson, así como con sus cuidadores y familiares. Me alegra poder ayudarlos con los recursos que ofrece la Fundación. Es importante que sepan que no están solos; que sepan que en la Parkinson’s Foundation hay muchas personas trabajando para lograr tener una cura en un futuro.

Es importante para mí llevar toda esta información en español a mi comunidad latina, ya que aún hay estigmas y miedos que tenemos que quitar acerca de la enfermedad de Parkinson.

Recientemente, pude participar en la elaboración de un anuncio de servicio a la comunidad para la Fundación que se hizo en español e inglés. Para mí, fue emocionante saber que estaba en español porque la información llegará a la comunidad hispanohablante en nuestro idioma.

¡La importancia de este comercial es para que sepan que no están solos y que pueden acercarse a la Fundación y encontrar muchos recursos en español!

¡Espero que puedan compartir con las personas para que sepa que la Parkinson Foundation es una comunidad que los puede ayudar y guiar!

Yo seguiré educándome y llevando los recursos en eventos de salud, presentaciones y participando en la carrera de la Parkinson’s Foundation donde espero conocerlos y platicar.