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Earlier intervention possible for postural hypotension in Parkinson's Disease

posted 28 Mar 2016, 08:29 by Philip O'Connell   [ updated 25 Aug 2016, 02:58 by Hollie O'Connell ]

City Hospitals Sunderland 
NHS Foundation Trust 

Rachael Forbister 
NHS Sunderland CCG 


28 March 2016 

Sitting and standing blood pressure in patients with Parkinson's Disease 



Led by the Parkinson's Disease Nurse Specialist Team (PDNS), Florence is reinforcing the shared management plan for patients with Parkinson's Disease at City Hospitals Sunderland demonstrating a positive impact on patient’s clinical management to reduce the risk of hospitalisation due to postural hypertension.  

Postural hypotension, in a patient group who often have issues with imbalance, and whose symptoms are often exacerbated by concurrent medication and co-morbidity, are at high risk of falls and hospitalisation.  Florence was therefore selected to support patients in their shared management by taking their blood pressure at home to understand the impact of more proactive shared-management.   

As falls are the second highest cause of admission to hospital for patients with Parkinson's Disease, the early detection and monitoring  of postural drop can be more effectively managed within the community setting, thereby potentially reducing the incidence of falls and hospital admission resulting from this providing a much better outcome for both the patient and their family.

Patients/carers were educated on how to take a blood pressure reading and supplied with a blood pressure machine to use and prompted by Florence to send their sitting and standing blood pressure readings 3 times per week on alternate days. After 3 months, the blood pressure readings for each patient were reviewed, and an alert threshold set for each patient based upon the mean average of the blood pressure readings. The alerts were set to trigger as dictated, and once triggered, Florence would inform the PDNS team, and the patient was advised by Florence to contact the team for advice.

There were 10 original patients involved in the pilot with 8 participants demonstrating at least 1 episode of low BP with several demonstrating repeated instances where the patient was advised to contact the PDNS team for further advice and early intervention was initiated.

The team concluded that Florence has definite potential to be used in the monitoring of patients with Parkinson's Disease to determine the risk of postural hypotension.  The ability to configure Florence to highlight low blood pressure issues in patients created opportunities for earlier intervention that may not have been uncovered otherwise; particularly as although patients often have routine sitting blood pressure checks at GP practices and at hospital clinic appointments, many patients report that a standing blood pressure is not usually routinely  undertaken at these times. 

Given that the Parkinson's Disease patient population is generally older, and often patients have multiple co-morbidities, the opportunity for more proactive monitoring of sitting and standing BP in the patients home, on a consistent basis should be further explored based on the results so far with a reasonable proportion of the patient population being able to use Florence. 

For more information please contact Rachael Forbister, Telehealth Lead and Project Manager, Sunderland CCG  rachael.forbister@nhs.net 


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