Original articleEffects of Patient-Controlled Abdominal Compression on Standing Systolic Blood Pressure in Adults With Orthostatic Hypotension
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.
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Cited by (30)
Management of neurogenic orthostatic hypotension in the heart failure patient
2020, Autonomic Neuroscience: Basic and ClinicalCitation Excerpt :However, lower pressures may be sufficient when using an abdominal binder alone. In a subsequent study it was shown that an abdominal binder with 10 mmHg applied prior to standing was sufficient to improve OH (Figueroa et al., 2015). A study by Okamoto et al. compared the use of an automated inflatable abdominal binder to midodrine and demonstrated that the binder was as effective as midodrine in improving orthostatic tolerance and decreasing orthostatic symptoms (Okamoto et al., 2016).
Nonpharmacologic Management of Orthostatic Hypotension in Older People: A Systematic Review. The SENATOR ONTOP Series
2019, Journal of the American Medical Directors AssociationCitation Excerpt :The baseline SSS-OI score of 35.2 ± 12.1 decreased to 22.5 ± 11.3 (P = .01) after 1 month therapy, indicating significant symptom improvement. Another study38 compared no abdominal compression with a conventional elastic abdominal binder in 13 patients with neurogenic OH and measured severity of OH symptoms using Orthostatic Symptoms Scale (OSS).38 Median baseline OSS score improved from 5.0 points to −0.5 points 5 minutes after standing with conventional elastic abdominal binder.
Autonomic dysfunction: Diagnosis and management
2019, Handbook of Clinical NeurologyCitation Excerpt :Maintaining volume expansion with dietary intake of 6–10 g of sodium per day in addition to hydration with a minimum of 1.25–2.50 L of fluid has been found to be beneficial in order to balance expected 24-h urine losses (Shannon et al., 2002; Humm et al., 2008). Physical counter pressure maneuvers such as leg crossing, static handgrip, squatting, and general muscle tensing have been found to increase cardiac output and systemic BP, thus improving some of the clinical symptoms associated with OH (van Lieshout et al., 1992; Clarke et al., 2010; Figueroa et al., 2015). Compression stockings and abdominal binders, which help minimize peripheral blood pooling have been found to reduce the degree of orthostatic BP fall and minimize symptoms in selected patients (Henry et al., 1999; Podoleanu et al., 2006).
Pure autonomic failure
2019, Handbook of Clinical NeurologyCitation Excerpt :Interventions such as slow changes in posture, avoidance of large meals (eating multiple small meals) and hot environments, and raising the head of the bed during sleep can help mitigate symptoms of supine hypertension and neurogenic orthostatic hypotension associated with PAF. Other maneuvers such as leg-crossing, squatting, and the application of compression stockings and abdominal binders can be helpful (Figueroa et al., 2015). Abdominal binders, as demonstrated by Okamoto and colleagues (2016), that inflate only when the patient stands up are quite effective in the management of hypotension.
Orthostatic hypotension; that great unknown
2017, Semergen
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.