title: Combined counter-maneuvers accelerate recovery from orthostatic hypotension in familial dysautonomia.
abstract: BACKGROUND
  In patients with familial dysautonomia (FD), prominent orthostatic hypotension (OH) endangers cerebral perfusion. Supine repositioning or abdominal compression improves systolic and diastolic blood pressure (BPsys and BPdia).
  
  
  OBJECTIVE
  To determine whether OH recovers faster with combined supine repositioning and abdominal compression than with supine repositioning alone.
  
  
  METHODS
  In 9 patients with FD (17.8 ± 3.9 years) and 10 healthy controls (18.8 ± 5 years), we assessed 2-min averages of BPsys, BPdia, and heart rate (HR) during supine rest, standing, supine repositioning, another supine rest, second standing, and supine repositioning with abdominal compression by leg elevation and flexion. We determined BPsys- and BPdia-recovery-times as intervals from return to supine until BP reached values equivalent to each participant's 2-min average at supine rest minus two standard deviations. Differences in signal values and BP-recovery-times between groups and positions were assessed by ANOVA and post hoc testing (significance: P < 0.05).
  
  
  RESULTS
  Patients with FD had pronounced OH that improved with supine repositioning. However, BP only reached supine rest values with additional abdominal compression. In controls, BP was stable during positional changes. Without abdominal compression, BP-recovery-times were longer in patients with FD than those in controls, but similar to control values with compression (BPsys: 83.7 ± 64.1 vs 36.6 ± 49.5 s; P = 0.013; BPdia: 84.6 ± 65.2 vs 35.3 ± 48.9 s; P = 0.009).
  
  
  CONCLUSIONS
  Combining supine repositioning with abdominal compression significantly accelerates recovery from OH and thus lowers the risk of hypotension-induced cerebral hypoperfusion.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Germany. max.hilz@uk-erlangen.de
authors.forename: M J
authors.initials: MJ
authors.lastname: Hilz
authors.forename: E C
authors.initials: EC
authors.lastname: Ehmann
authors.forename: E
authors.initials: E
authors.lastname: Pauli
authors.forename: R
authors.initials: R
authors.lastname: Baltadzhieva
authors.forename: J
authors.initials: J
authors.lastname: Koehn
authors.forename: S
authors.initials: S
authors.lastname: Moeller
authors.forename: P
authors.initials: P
authors.lastname: DeFina
authors.forename: F B
authors.initials: FB
authors.lastname: Axelrod
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D004402:Dysautonomia, Familial / Q000150:complications*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology* / Q000534:rehabilitation*; D008297:Male; D005082:Physical Exertion / Q000502:physiology*; D020127:Recovery of Function; D018709:Statistics, Nonparametric; D016683:Supine Position; D013997:Time Factors; D055815:Young Adult