Abstract
Objective
To assess the effects of patient-controlled abdominal compression on postural changes
in systolic blood pressure (SBP) associated with orthostatic hypotension (OH). Secondary
variables included subject assessments of their preferences and the ease-of-use.
Design
Randomized crossover trial.
Setting
Clinical research laboratory.
Participants
Adults with neurogenic OH (N=13).
Interventions
Four maneuvers were performed: moving from supine to standing without abdominal compression;
moving from supine to standing with either a conventional or an adjustable abdominal
binder in place; application of subject-determined maximal tolerable abdominal compression
while standing; and while still erect, subsequent reduction of abdominal compression
to a level the subject believed would be tolerable for a prolonged period.
Main Outcome Measures
The primary outcome variable included postural changes in SBP. Secondary outcome variables
included subject assessments of their preferences and ease of use.
Results
Baseline median SBP in the supine position was not affected by mild (10mmHg) abdominal
compression prior to rising (without abdominal compression: 146mmHg; interquartile
range, 124–164mmHg; with the conventional binder: 145mmHg; interquartile range, 129–167mmHg;
with the adjustable binder: 153mmHg, interquartile range, 129–160mmHg; P=.85). Standing without a binder was associated with an −57mmHg (interquartile range,
−40 to −76mmHg) SBP decrease. Levels of compression of 10mmHg applied prior to rising
with the conventional and adjustable binders blunted these drops to −50mmHg (interquartile
range, −33 to −70mmHg; P=.03) and −46mmHg (interquartile range, −34 to −75mmHg; P=.01), respectively. Increasing compression to subject-selected maximal tolerance
while standing did not provide additional benefit and was associated with drops of
−53mmHg (interquartile range, −26 to −71mmHg; P=.64) and −59mmHg (interquartile range, −49 to −76mmHg; P=.52) for the conventional and adjustable binders, respectively. Subsequent reduction
of compression to more tolerable levels tended to worsen OH with both the conventional
(−61mmHg; interquartile range, −33 to −80mmHg; P=.64) and adjustable (−67mmHg; interquartile range, −61 to −84mmHg; P=.79) binders. Subjects reported no differences in preferences between the binders
in terms of preference or ease of use.
Conclusions
These results suggest that mild (10mmHg) abdominal compression prior to rising can
ameliorate OH, but further compression once standing does not result in additional
benefit.
Keywords
List of abbreviations:
DBP (diastolic blood pressure), IQR (interquartile range), OH (orthostatic hypotension), SBP (systolic blood pressure), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 05, 2014
Footnotes
Supported in part by the National Institutes of Health Training Grant under the Ruth L. Kirschstein National Research Service Award (award no. T32 HD007447); Autonomic Disorders Program Project (grant no. NS 32352); Pathogenesis and Diagnosis of Multiple System Atrophy (grant no. NS 44233); Autonomic Rare Disease Clinical Consortium (grant no. U54 NS065736); Mayo Center for Clinical and Translational Science (grant no. UL1 RR24150); Differential Approach to the Postural Tachycardia Syndrome (grant no. K23NS075141); and Mayo Funds.
The Autonomic Diseases Consortium is a part of the National Institutes of Health Rare Diseases Clinical Research Network. Funding and/or programmatic support provided by the National Institute of Neurological Diseases and Stroke (grant no. U54 NS065736) and National Institutes of Health Office of Rare Diseases Research.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
