title: Effects of patient-controlled abdominal compression on standing systolic blood pressure in adults with orthostatic hypotension.
abstract: OBJECTIVE
  To assess the effects of patient-controlled abdominal compression on postural changes in systolic blood pressure (SBP) associated with orthostatic hypotension (OH). Secondary variables included subject assessments of their preferences and the ease-of-use.
  
  
  METHODS
  Randomized crossover trial.
  
  
  METHODS
  Clinical research laboratory.
  
  
  METHODS
  Adults with neurogenic OH (N=13).
  
  
  METHODS
  Four maneuvers were performed: moving from supine to standing without abdominal compression; moving from supine to standing with either a conventional or an adjustable abdominal binder in place; application of subject-determined maximal tolerable abdominal compression while standing; and while still erect, subsequent reduction of abdominal compression to a level the subject believed would be tolerable for a prolonged period.
  
  
  METHODS
  The primary outcome variable included postural changes in SBP. Secondary outcome variables included subject assessments of their preferences and ease of use.
  
  
  RESULTS
  Baseline median SBP in the supine position was not affected by mild (10mmHg) abdominal compression prior to rising (without abdominal compression: 146mmHg; interquartile range, 124-164mmHg; with the conventional binder: 145mmHg; interquartile range, 129-167mmHg; with the adjustable binder: 153mmHg, interquartile range, 129-160mmHg; P=.85). Standing without a binder was associated with an -57mmHg (interquartile range, -40 to -76mmHg) SBP decrease. Levels of compression of 10mmHg applied prior to rising with the conventional and adjustable binders blunted these drops to -50mmHg (interquartile range, -33 to -70mmHg; P=.03) and -46mmHg (interquartile range, -34 to -75mmHg; P=.01), respectively. Increasing compression to subject-selected maximal tolerance while standing did not provide additional benefit and was associated with drops of -53mmHg (interquartile range, -26 to -71mmHg; P=.64) and -59mmHg (interquartile range, -49 to -76mmHg; P=.52) for the conventional and adjustable binders, respectively. Subsequent reduction of compression to more tolerable levels tended to worsen OH with both the conventional (-61mmHg; interquartile range, -33 to -80mmHg; P=.64) and adjustable (-67mmHg; interquartile range, -61 to -84mmHg; P=.79) binders. Subjects reported no differences in preferences between the binders in terms of preference or ease of use.
  
  
  CONCLUSIONS
  These results suggest that mild (10mmHg) abdominal compression prior to rising can ameliorate OH, but further compression once standing does not result in additional benefit.
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Figueroa
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Singer
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Paola
authors.initials: P
authors.lastname: Sandroni
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: David M
authors.initials: DM
authors.lastname: Sletten
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Tonette L
authors.initials: TL
authors.lastname: Gehrking
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Jade A
authors.initials: JA
authors.lastname: Gehrking
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Phillip
authors.initials: P
authors.lastname: Low
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: basford.jeffrey@mayo.edu.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Basford
mesh_terms: D000005:Abdomen / Q000502:physiology*; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D005676:Gravity Suits; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011187:Posture / Q000502:physiology*; D011312:Pressure; D012720:Severity of Illness Index; D013599:Systole / Q000502:physiology; D016896:Treatment Outcome
keywords: Orthostatic intolerance; Rehabilitation