TY - JOUR
T1 - Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension
AU - Denq, J. C.
AU - Opfer-Gehrking, T. L.
AU - Giuliani, M.
AU - Felten, J.
AU - Converti, V. A.
AU - Low, P. A.
N1 - Funding Information:
This work was supported in part by grants from NINDS (PO1 NS32352), NASA, and Mayo funds.
PY - 1997
Y1 - 1997
N2 - Orthostatic hypotension (OH) is the most disabling and serious manifestation of adrenergic failure, occurring in the autonomic neuropathies, pure autonomic failure (PAF) and multiple system atrophy (MSA). No specific treatment is currently available for most etiologies of OH. A reduction in venous capacity, secondary to some physical counter maneuvers (e.g., squatting or leg crossing), or the use of compressive garments, can ameliorate OH. However, there is little information on the differential efficacy, or the mechanisms of improvement, engendered by compression of specific capacitance beds. We therefore evaluated the efficacy of compression of specific compartments (calves, thighs, low abdomen, calves and thighs, and all compartments combined), using a modified antigravity suit, on the end-points of orthostatic blood pressure, and symptoms of orthostatic intolerance. Fourteen patients (PAF, n = 9; MSA, n = 3; diabetic autonomic neuropathy, n = 2; five males and nine females) with clinical OH were studied. The mean age was 62 years (range 31-78). The mean ± SEM orthostatic systolic blood pressure when all compartments were compressed was 115.9 ± 7.4 mmHg, significantly improved (p < 0.001) over the head-up tilt value without compression of 89.6 ± 7.0 mmHg. The abdomen was the only single compartment whose compression significantly reduced OH (p < 0.005). There was a significant increase of peripheral resistance index (PRI) with compression of abdomen (p < 0.001) or all compartments (p < 0.001); end-diastolic index and cardiac index did not change. We conclude that denervation increases vascular capacity, and that venous compression improves OH by reducing this capacity and increasing PRI. Compression of all compartments is the most efficacious, followed by abdominal compression, whereas leg compression alone was less effective, presumably reflecting the large capacity of the abdomen relative to the legs.
AB - Orthostatic hypotension (OH) is the most disabling and serious manifestation of adrenergic failure, occurring in the autonomic neuropathies, pure autonomic failure (PAF) and multiple system atrophy (MSA). No specific treatment is currently available for most etiologies of OH. A reduction in venous capacity, secondary to some physical counter maneuvers (e.g., squatting or leg crossing), or the use of compressive garments, can ameliorate OH. However, there is little information on the differential efficacy, or the mechanisms of improvement, engendered by compression of specific capacitance beds. We therefore evaluated the efficacy of compression of specific compartments (calves, thighs, low abdomen, calves and thighs, and all compartments combined), using a modified antigravity suit, on the end-points of orthostatic blood pressure, and symptoms of orthostatic intolerance. Fourteen patients (PAF, n = 9; MSA, n = 3; diabetic autonomic neuropathy, n = 2; five males and nine females) with clinical OH were studied. The mean age was 62 years (range 31-78). The mean ± SEM orthostatic systolic blood pressure when all compartments were compressed was 115.9 ± 7.4 mmHg, significantly improved (p < 0.001) over the head-up tilt value without compression of 89.6 ± 7.0 mmHg. The abdomen was the only single compartment whose compression significantly reduced OH (p < 0.005). There was a significant increase of peripheral resistance index (PRI) with compression of abdomen (p < 0.001) or all compartments (p < 0.001); end-diastolic index and cardiac index did not change. We conclude that denervation increases vascular capacity, and that venous compression improves OH by reducing this capacity and increasing PRI. Compression of all compartments is the most efficacious, followed by abdominal compression, whereas leg compression alone was less effective, presumably reflecting the large capacity of the abdomen relative to the legs.
KW - Antigravity suit
KW - Blood pressure
KW - Multiple system atrophy
KW - Orthostatic hypotension
KW - Pure autonomic failure
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U2 - 10.1007/BF02267725
DO - 10.1007/BF02267725
M3 - Article
C2 - 9430805
AN - SCOPUS:0030671512
SN - 0959-9851
VL - 7
SP - 321
EP - 326
JO - Clinical Autonomic Research
JF - Clinical Autonomic Research
IS - 6
ER -