title: The effect of sleeping with the head of the bed elevated six inches on elderly patients with orthostatic hypotension: an open randomised controlled trial.
abstract: BACKGROUND
  the evidence for 6-inch tilt sleeping-head-up (SHU), a common therapy for the treatment of orthostatic hypotension (OH) in older people, is unavailable.
  
  
  OBJECTIVE
  to investigate the effects of 6-inch SHU for 6 weeks in community-living patients with chronic OH.
  
  
  METHODS
  open labelled randomised controlled trial.
  
  
  METHODS
  one hundred patients aged ≥60 with chronic OH were randomised into SHU or control groups. Primary outcome measures were mean arterial pressure (MAP) and symptoms. Repeated measures of orthostatic haemodynamic parameters (systolic blood pressure, diastolic blood pressure, MAP, heart rate, percentage change of Modelflow parameters), weight, frequency of dizziness, 24-h urinary sodium and volume, 24-h ambulatory blood pressure (24-ABPM) and presence of ankle oedema were collected at baseline and at 6 weeks.
  
  
  RESULTS
  symptoms improved, to a similar extent, in both groups. There were no differences in MAP or other haemodynamic parameters, weight, urinary volume or 24-ABPM between SHU and controls. SHU were more likely to have leg oedema.
  
  
  CONCLUSIONS
  these findings suggested that SHU at 6 inches has no additional effects on symptoms or haemodynamic parameters at 6 weeks than existing non-pharmacological measures in older patients with OH. Its use in this group should therefore be discouraged.
authors.affiliation: Mercer's Institute for Research on Ageing (MIRA), St James's Hospital, Dublin 8, Ireland. cfan@stjames.ie
authors.forename: Chie Wei
authors.initials: CW
authors.lastname: Fan
authors.forename: Cathal
authors.initials: C
authors.lastname: Walsh
authors.forename: Conal J
authors.initials: CJ
authors.lastname: Cunningham
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000704:Analysis of Variance; D001513:Beds; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D004487:Edema / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D011187:Posture; D012890:Sleep; D013997:Time Factors; D016896:Treatment Outcome; D014563:Urodynamics