Original article
Effects of Patient-Controlled Abdominal Compression on Standing Systolic Blood Pressure in Adults With Orthostatic Hypotension

https://doi.org/10.1016/j.apmr.2014.10.012Get rights and content

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.

Section snippets

Methods

This randomized crossover treatment trial was reviewed and approved by our institutional review board and carried out in the Research Autonomic Laboratory at the Mayo Clinic in Rochester, Minnesota, between July 2010 and June 2012. All subjects signed informed consent prior to participation. Trials took place during the morning in a room at ambient temperature of 22°C to 24°C. Subjects were told to maintain good hydration and fast for at least 4 hours before testing. They were also instructed

Results

The study group consisted of 13 adults (6 women, 7 men) with neurogenic OH who had been symptomatic for periods ranging from 1 to 18 years (table 1). The effects of the standing maneuvers and binder adjustments are subsequently summarized and presented in figure 2.

Discussion

The major findings of this study are that although mild (10mmHg) abdominal compression prior to rising provided modest improvement in standing blood pressure, once standing, further subject-controlled compression adjustments did not produce additional benefit. Contrary to our hypothesis, self-adjustment of abdominal bind pressures once a subject was standing proved to be an ineffective add-on maneuver. Subject assessments were similar in that they reported no preferences between the 2 binders

Conclusions

The donning of an abdominal binder prior to rising is effective in ameliorating OH, but further upright adjustment of compression, at least under the conditions of this study, did not provide additional subjective or objective benefit. Subjects using abdominal binders should consider physical countermaneuvers15 or prompt postural changes (sitting or lying down) at the first warning of orthostatic deterioration rather than attempting to adjust their binders.

Suppliers

  • a.

    TNO BMI.

  • b.

    DeRoyal Industries Inc.

  • c.

    Aspen Medical Products.

References (19)

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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.

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