Clinical Autonomic Research

, Volume 7, Issue 6, pp 321–326

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. Convertino
  • P. A. Low
Research Paper

DOI: 10.1007/BF02267725

Cite this article as:
Denq, J.C., Opfer-Gehrking, T.L., Giuliani, M. et al. Clinical Autonomic Research (1997) 7: 321. doi:10.1007/BF02267725

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.

Keywords

orthostatic hypotension antigravity suit pure autonomic failure multiple system atrophy blood pressure 

Copyright information

© Rapid Science Publishers 1997

Authors and Affiliations

  • J. -C. Denq
    • 1
  • T. L. Opfer-Gehrking
    • 2
  • M. Giuliani
    • 3
  • J. Felten
    • 2
  • V. A. Convertino
    • 4
  • P. A. Low
    • 2
  1. 1.Department of Neurology, National Defense Medical CenterTri-Service General HospitalTaipeiRepublic of China
  2. 2.Autonomic Disorders Research Center, Department of NeurologyMayo ClinicRochesterUSA
  3. 3.Department of NeurologyUniversity of PittsburghPittsburghUSA
  4. 4.Clinical Sciences DivisionPhysiology Research BranchBrooks Air Force BaseUSA

Personalised recommendations