Clinical Autonomic Research

, Volume 7, Issue 6, pp 321–326 | Cite as

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

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 

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References

  1. 1.
    Low PA. The effect of aging on the autonomic nervous system. In: Low PA, ed.Clinical Autonomic Disorders: Evaluation and Management. Boston: Little, Brown and Company, 1993; 685–700.Google Scholar
  2. 2.
    Fealey RD, Robertson D. Management of orthostatic hypotension. In: Low PA ed.Clinical Autonomic Disorders: Evaluation and Management. Boston: Little, Brown and Company, 1993; 731–743.Google Scholar
  3. 3.
    Low PA. Neurogenic orthostatic hypotension. In: Johnson R, ed.Current Therapy in Neurologic Disease, 4th edn. Philadelphia: Mosby Year Book, 1994; 21–26.Google Scholar
  4. 4.
    Sheps SG. Use of an elastic garment in the treatment of orthostatic hypotension.Cardiology 1976;61(suppl. 1): 271–279.Google Scholar
  5. 5.
    Anonymous Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy.Neurology 1996;46: 1470.Google Scholar
  6. 6.
    Benarroch EE, Opfer-Gehrking TL, Low PA. Use of the photoplethysmographic technique to analyze the Valsalva maneuver in normal man.Muscle Nerve 1991;14: 1165–1172.Google Scholar
  7. 7.
    Low PA. Autonomic nervous system function.J Clin Neurophysiol 1993;10: 14–27.Google Scholar
  8. 8.
    Low PA. Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure.Mayo Clin Proc 1993;68: 748–752.Google Scholar
  9. 9.
    Sjostrand T. Volume and distribution of blood and their significance in regulating the circulation.Physiol Rev 1953;33: 202–225.Google Scholar
  10. 10.
    Rowell LB, Detry JM, Blackmon JR, Wyss C. Importance of the splanchnic vascular bed in human blood pressure regulation.J Appl Physiol 1972;32: 213–220.Google Scholar
  11. 11.
    Maule S, Chaudhuri KR, Thomaides T, Pavitt D, McCleery J, Mathias CJ. Effects of oral alcohol on superior mesenteric artery blood flow in normal man, horizontal and tilted.Clin Sci 1993;84: 419–425.Google Scholar
  12. 12.
    Wilkins RW, Culbertson JW, Inglefinger FJ. The effect of splanchnic sympathectomy in hypertensive patients upon estimated hepatic blood flow in the upright as contrasted with the horizontal position.J Clin Invest 1951;30: 312.Google Scholar
  13. 13.
    Tanaka H, Yamaguchi H, Tamai H. An inflatable abdominal band raises standing blood pressure in patients with orthostatic intolerance.Clin Auton Res 1996;6: 291–292 (Abstract).Google Scholar
  14. 14.
    Tenny SM, Honig CR. The effect of the anti-G-suite on the ballistocardiogram.J Aviat Med 1955;26: 194–199.Google Scholar
  15. 15.
    Streeten DH, Anderson GH Jr, Richardson R, Thomas FD. Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling.J Lab Clin Med 1988;111: 326–335.Google Scholar
  16. 16.
    Brook WH. Postural hypotension and the anti-gravity suit. Review.Aust Fam Physician 1994;23: 1948–1949.Google Scholar
  17. 17.
    Geelen G, Arbeille P, Saumet JL, Cottet-Emard JM, Patat F, Vincent M. Hemodynamic and hormonal effects of prolonged anti-G suit inflation in humans.J Appl Physiol 1992;72: 977–984.Google Scholar
  18. 18.
    Sieker HO, Burnum JF, Hickam JB, Penrod KE. Treatment of postural hypotension with a counterpressure garment.JAMA 1954;161: 132–135.Google Scholar
  19. 19.
    Bouvette CM, McPhee BR, Opfer-Gehrking TL, Low PA. Role of physical countermaneuvers in the management of orthostatic hypotension: Efficacy and biofeedback augmentation.Mayo Clin Proc 1996;71: 847–853.Google Scholar
  20. 20.
    Joyner MJ, Shepherd JT. Autonomic control of circulation. In: Low PA, ed.Clinical Autonomic Disorders: Evaluation and Management. Boston: Little, Brown and Company, 1993; 55–67.Google Scholar
  21. 21.
    Lewis BS. Effects of standing and squatting on echocardiographic left ventricular function.Eur J Cardiol 1980;11: 405–412.Google Scholar
  22. 22.
    Bannister R, Mathias CJ. Management of postural hypotension. In: Bannister R, Mathias CJ, eds.Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System. Oxford: Oxford University Press, 1992; 622–645.Google Scholar
  23. 23.
    Low PA. Laboratory evaluation of autonomic failure. In: Low PA, ed.Clinical Autonomic Disorders: Evaluation and Management. Boston: Little, Brown and Company, 1993; 169–195.Google Scholar

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

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