Effects of patient-controlled abdominal compression on standing systolic blood pressure in adults with orthostatic hypotension.

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.

• Authors: Juan J Figueroa, Wolfgang Singer, Paola Sandroni, David M Sletten, Tonette L Gehrking, Jade A Gehrking, Phillip Low, Jeffrey R Basford
• Journal: Archives of physical medicine and rehabilitation (Arch Phys Med Rehabil) Vol. 96 Issue 3 Pg. 505-10 (Mar 2015) ISSN: 1532-821X [Electronic] United States
• PMID: 25448247 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Topics

• Abdomen (physiology)
• Aged
• Blood Pressure (physiology)
• Blood Pressure Monitoring, Ambulatory
• Cross-Over Studies
• Equipment Design
• Female
• Gravity Suits
• Humans
• Hypotension, Orthostatic (physiopathology, rehabilitation)
• Male
• Middle Aged
• Minnesota
• Posture (physiology)
• Pressure
• Severity of Illness Index
• Systole (physiology)
• Treatment Outcome