Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension

J. C. Denq, T. L. Opfer-Gehrking, M. Giuliani, J. Felten, V. A. Converti, Phillip Anson Low

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)321-326
Number of pages6
JournalClinical Autonomic Research
Volume7
Issue number6
StatePublished - 1997

Fingerprint

Orthostatic Hypotension
Abdomen
Pure Autonomic Failure
Multiple System Atrophy
Leg
Thigh
Blood Pressure
Vascular Resistance
Gravity Suits
Orthostatic Intolerance
Clothing
Diabetic Neuropathies
Denervation
Adrenergic Agents
Blood Vessels
Head

Keywords

  • Antigravity suit
  • Blood pressure
  • Multiple system atrophy
  • Orthostatic hypotension
  • Pure autonomic failure

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Denq, J. C., Opfer-Gehrking, T. L., Giuliani, M., Felten, J., Converti, V. A., & Low, P. A. (1997). Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension. Clinical Autonomic Research, 7(6), 321-326.

Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension. / Denq, J. C.; Opfer-Gehrking, T. L.; Giuliani, M.; Felten, J.; Converti, V. A.; Low, Phillip Anson.

In: Clinical Autonomic Research, Vol. 7, No. 6, 1997, p. 321-326.

Research output: Contribution to journalArticle

Denq, JC, Opfer-Gehrking, TL, Giuliani, M, Felten, J, Converti, VA & Low, PA 1997, 'Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension', Clinical Autonomic Research, vol. 7, no. 6, pp. 321-326.
Denq, J. C. ; Opfer-Gehrking, T. L. ; Giuliani, M. ; Felten, J. ; Converti, V. A. ; Low, Phillip Anson. / Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension. In: Clinical Autonomic Research. 1997 ; Vol. 7, No. 6. pp. 321-326.
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