Abstract
ObjectiveTo determine the efficacy and safety of nonpharmacologic interventions for orthostatic hypotension (OH) secondary to aging.MethodsA total of 150 orthostatic challenges were performed in 25 older people (age 60–92 years) to determine cardiovascular responses to bolus water drinking, compression stockings, abdominal compression, and physical countermaneuvers. Primary outcome was response rate as assessed by proportion of participants whose systolic blood pressure (SBP) drop improved by ≥10 mm Hg.ResultsThe response rate to bolus water drinking was 56% (95% confidence interval [CI] 36.7–74.2), with standing SBP increasing by 12 mm Hg (95% CI 4–20). Physical countermaneuvers were efficacious in 44% (95% CI 25.8–63.3) but had little effect on standing SBP (+7.5 mm Hg [95% CI −1 to 16]). Abdominal compression was efficacious in 52% (95% CI 32.9–70.7) and improved standing SBP (+10 mm Hg [95% CI 2–18]). Compression stockings were the least efficacious therapy (32% [95% CI 16.1–51.4]) and had little effect on standing SBP (+6 mm Hg [95% CI −1, 13]). No intervention improved symptoms during standing. There were no adverse events.ConclusionsBolus water drinking should become the standard first-line nonpharmacologic intervention, whereas compression stockings should be disregarded in this population.Classification of evidenceThis study provides Class III evidence that for older people with OH, bolus water drinking is superior to other nonpharmacologic interventions in decreasing SBP drop.
Highlights
A total of 150 orthostatic challenges were performed in 25 older people to determine cardiovascular responses to bolus water drinking, compression stockings, abdominal compression, and physical countermaneuvers
Bolus water drinking should become the standard first-line nonpharmacologic intervention, whereas compression stockings should be disregarded in this population
Classification of evidence This study provides Class III evidence that for older people with orthostatic hypotension (OH), bolus water drinking is superior to other nonpharmacologic interventions in decreasing systolic blood pressure (SBP) drop
Summary
A total of 150 orthostatic challenges were performed in 25 older people (age 60–92 years) to determine cardiovascular responses to bolus water drinking, compression stockings, abdominal compression, and physical countermaneuvers. Primary outcome was response rate as assessed by proportion of participants whose systolic blood pressure (SBP) drop improved by ≥10 mm Hg. Population All participants were >60 years of age and had OH according to international criteria.. Dysautonomia was confirmed on autonomic function testing and was judged to be secondary to aging (in the absence of other identifiable causes). Exclusions were dysphagia, fluid restriction, and inability to wear compression garments.
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