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Arch Phys Med Rehabil. 2015 Mar;96(3):505-10. doi: 10.1016/j.apmr.2014.10.012. Epub 2014 Nov 6.

Effects of patient-controlled abdominal compression on standing systolic blood pressure in adults with orthostatic hypotension.

Author information

1
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
2
Department of Neurology, Mayo Clinic, Rochester, MN.
3
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: basford.jeffrey@mayo.edu.

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.

DESIGN:

Randomized crossover trial.

SETTING:

Clinical research laboratory.

PARTICIPANTS:

Adults with neurogenic OH (N=13).

INTERVENTIONS:

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.

MAIN OUTCOME MEASURES:

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.

KEYWORDS:

Orthostatic intolerance; Rehabilitation

PMID:
25448247
PMCID:
PMC4339489
DOI:
10.1016/j.apmr.2014.10.012
[Indexed for MEDLINE]
Free PMC Article

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