The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging

OBJECTIVE: To determine the efficacy and safety of nonpharmacologic interventions for orthostatic hypotension (OH) secondary to aging. METHODS: A total of 150 orthostatic challenges were performed in 25 older people (age 60–92 years) to determine cardiovascular responses to bolus water drinking, compression stockings, abdominal compression, and physical countermaneuvers. Primary outcome was response rate as assessed by proportion of participants whose systolic blood pressure (SBP) drop improved by ≥10 mm Hg. RESULTS: The response rate to bolus water drinking was 56% (95% confidence interval [CI] 36.7–74.2), with standing SBP increasing by 12 mm Hg (95% CI 4–20). Physical countermaneuvers were efficacious in 44% (95% CI 25.8–63.3) but had little effect on standing SBP (+7.5 mm Hg [95% CI −1 to 16]). Abdominal compression was efficacious in 52% (95% CI 32.9–70.7) and improved standing SBP (+10 mm Hg [95% CI 2–18]). Compression stockings were the least efficacious therapy (32% [95% CI 16.1–51.4]) and had little effect on standing SBP (+6 mm Hg [95% CI −1, 13]). No intervention improved symptoms during standing. There were no adverse events. CONCLUSIONS: Bolus water drinking should become the standard first-line nonpharmacologic intervention, whereas compression stockings should be disregarded in this population. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for older people with OH, bolus water drinking is superior to other nonpharmacologic interventions in decreasing SBP drop.