Editors' note: The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging

Abstract

In “The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging,” Drs. Newton and Frith reported that when 56% of participants over age 60 consumed 480 mL of tap water 20 minutes before lying supine, they experienced significantly less systolic blood pressure drops upon standing than when they did not ingest the water. However, drinking water before transitioning from lying to standing had no significant effect on diastolic blood pressure drop or symptoms. Dr. Gupta responded to these findings by noting that improving the drop in systolic blood pressure is irrelevant if the rate of syncope development is unchanged. He further questioned the benefits of water consumption, stating that water cannot be fully absorbed within 5 minutes. Drs. Newton and Frith responded that even in the absence of syncope, symptoms of orthostatic hypotension (OH) lead to impairment. They also noted that water consumption is beneficial because it acts on osmoreceptors to stimulate the sympathetic nervous system. Drs. Gupta, Newton, and Frith agree, however, that skeletal muscle compression can prevent OH through improvement of venous return. When interpreting the results of this study, Dr. Vilanilam cautions that (1) OH should be defined as a systolic blood pressure drop of 30 mm Hg in patients with preexisting hypertension and (2) confounding factors, like bilateral carotid artery stenosis, minimize the effect of nonpharmacologic interventions on OH. In “The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging,” Drs. Newton and Frith reported that when 56% of participants over age 60 consumed 480 mL of tap water 20 minutes before lying supine, they experienced significantly less systolic blood pressure drops upon standing than when they did not ingest the water. However, drinking water before transitioning from lying to standing had no significant effect on diastolic blood pressure drop or symptoms.