Abstract
Overall management of these hypotensive conditions includes pharmacological and non-pharmacological treatments. Avoiding factors or triggers like sudden postural or positional change, large meals, hot shower, and alcohol forms part of the treatment and definitely the initial management of these conditions in different studies. The outcomes include blood pressure readings and time to symptoms and time to recovery. In this chapter, the potential benefit of non- pharmacological and relatively safe strategies will be discussed in detail.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Mills PB, Fung CK, Travlos A, et al. Nonpharmacologic management of orthostatic hypotension: a systematic review. Arch Phys Med Rehabil. 2015;96:366–75.
Rowell LB. Cardiovascular aspects of human thermoregulation. Circ Res. 1983;52:367–79.
Pathak A, Lapeyre-Mestre M, Montastruc JL, et al. Heat-related morbidity in patients with orthostatic hypotension and primary autonomic failure. Mov Disord. 2005;20:1213–9.
Petrofsky JS, Besonis C, Rivera D, et al. Impairment in orthostatic tolerance during heat exposure in individuals with type I and type II diabetes. Med Sci Monit. 2005;11:153–9.
Parsaik A, Allison TG, Singer W, et al. Deconditioning in patients with orthostatic intolerance. Neurology. 2012;79:1435–9.
Teri Harkell ADJ, Van Lieshout JJ, et al. Effects of leg muscle pumping and tensing on orthostatic arterial pressure: a study in normal subjects and patients with autonomic failure. Clin Sci. 1994;87:553–8.
Narkiewicz K, Cooley RL, Somers VK. Alcohol potentiates orthostatic hypotension: implications for alcohol-related syncope. Circulation. 2000;101:398–402.
Endo Y, Yamauchi K, Tsutsui Y, et al. Changes in blood pressure and muscle sympathetic nerve activity during water drinking in humans. Jpn J Physiol. 2002;52:421–7.
Rossi P, Andriesse GI, Oey PL, et al. Stomach distension increases efferent muscle sympathetic nerve activity and blood pressure in healthy humans. J Neurol Sci. 1998;161:148–55.
Lipp A, Tank J, Franke G, et al. Osmosensitive mechanisms contribute to the water-drinking-induced pressor response in humans. Neurology. 2005;65:905–7.
Jordan J, Shannon JR, Black BK, et al. The pressor response to water-drinking in humans: a sympathetic reflex? Circulation. 2000;101:504–9.
Mtinangi BL, Hainsworth R. Early effects of oral salt on plasma volume, orthostatic tolerance, and baroreceptor sensitivity in patients with syncope. Clin Auton Res. 1998;8:231–5.. (Rpt ref for salt).
Lahrmann H, Cortelli P, Hilz M, et al. EFNS guidelines on the diagnosis and management of orthostatic hypotension. Eur J Neurol. 2006;13:930–6.
Wieling W, Hainsworth R. Orthostatic tolerance: salt, water and the autonomic nervous system. Clin Auton Res. 2002;12:234–5.
Deguchi K, Ikeda K, Sasaki I, et al. Effects of daily water drinking on orthostatic and postprandial hypotension in patients with multiple system atrophy. J Neurol. 2007;254:735–40.
Waters WW, Platts SH, Mitchell BM, et al. Plasma volume restoration with salt tablets and water after bed rest prevents orthostatic hypotension and changes in supine hemodynamic and endocrine variables. Am J Physiol Heart Circ Physiol. 2005;288(2):H839–47.
Van Lieshout JJ, Ten Harkel DJ, Wieling W. Fludrocortisone and sleeping in the head up position limit the postural decrease in cardiac output in autonomic failure. Clin Auton Res. 2000;10:35–42.
Fan CW, Walsh C, Cunningham CJ. The effect of sleeping with the head of the bed elevated six inches on elderly patients with orthostatic hypotension and open randomized controlled trial. Age Ageing. 2011;40:187–92.
Maclean A, Allen E. Orthostatic hypotension and orthostatic tachycardia: Treatment with the head- up bed. J Am Med Ass. 1940;115:2162–7.
Bannister R, Sever P, Gross M. Cardiovascular reflexes and biochemical responses in progressive autonomic failure. Brain. 1977;100:327–44.
Denq JC, Opfer-Gehrking TL, Giuliani M, et al. Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension. Clin Auton Res. 1997;7(6):321–6.
Smeenk HE, Koster MJ, Faaij RA, et al. Compression therapy in patients with orthostatic hypotension: a systematic review. Neth J Med. 2014;72(2):80–5.
Podoleanu C, Maggi R, Brignole M, et al. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons: a randomized single-blind controlled study. J Am Coll Cardiol. 2006;48(7):1425–32.
Newton JL, Frith J. The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging. Neurology. 2018;91(7):e652–6.
Son JT, Lee E. Effect of water drinking on the postprandial fall of blood pressure in the elderly. J Korean Acad Fundam Nurs. 2010;17(3):304–13.
Shannon JR, Diedrich A, Biaggioni I, et al. Water drinking as a treatment for orthostatic syndromes. Am J Med. 2002;112:355–60.
Tae Son J, Lee E. Comparison of postprandial blood pressure reduction in the elderly by different body position. Geriatr Nurs. 2013;34:282–8.
Jonsson PV, Lipsitz LA, Kelley M, et al. Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls. Arch Intern Med. 1990;150:1518–24.
Oberman AS, Harada RK, Gagnon MM, et al. Effects of postprandial walking exercise on meal-related hypotension in frail elderly patients. Am J Cardiol. 1999;84:1130–2.
Nair S, Visvanathan R, Gentilcore D. Intermittent walking: a potential treatment for older people with postprandial hypotension. J Am Med Dir Assoc. 2015;16:160–4.
Potter JF, Heseltine D, Hartley G, et al. Effects of meal composition on the postprandial blood pressure, catecholamine and insulin changes in elderly subjects. Clin Sci (Lond). 1989;77:265–72.
Heseltine D, Dakkak M, Macdonald IA, et al. Effects of carbohydrate type on postprandial blood pressure, neuroendocrine and gastrointestinal hormone changes in the elderly. Clin Auton Res. 1991;1:219–24.
Visvanathan R, Horowitz M, Chapman I. The hypotensive response to oral fat is comparable but slower compared with carbohydrate in healthy elderly subjects. Br J Nutr. 2006;95:340–5.
Masuda Y, Kawamura A. Role of the autonomic nervous system in postprandial hypotension in elderly persons. J Cardiovasc Pharmacol. 2003;42:S23–6.
Fagius J, Ellerfelt K, Lithell H, et al. Increase in muscle nerve sympathetic activity after glucose intake is blunted in the elderly. Clin Auton Res. 1996;6:195–203.
Mitro P, Feterik K, Lenártová M, et al. Humoral mechanisms in the pathogenesis of postprandial hypotension in patients with essential hypertension. Wien Klin Wochenschr. 2001;113:424–32.
Tae Son J, Lee E. Effects of the amount of rice in meals on postprandial blood pressure in older people with postprandial hypotension: a within-subjects design. J Clin Nurs. 2015;24:2277–85.
Vloet LC, Mehagnoul-Schipper DJ, Hoefnagels WH, et al. The influence of low-, normal-, and high-carbohydrate meals on blood pressure in elderly patients with postprandial hypotension. J Gerontol A Biol Sci Med Sci. 2001;56:M744–8.
Sun WM, Houghton LA, Read NW, et al. Effect of meal temperature on gastric emptying of liquids in man. Gut. 1988;29:302–5.
Parry SW, Kenny RA. The management of vasovagal syncope. Q J Med. 1999;92:697–705.
Wieling W, Colman N, Krediet CT, Freeman R. Nonpharmacological treatment of reflex syncope. Clin Auton Res. 2004;14(Suppl 1):62–70.
Sheldon RS, Grubb BP, Olshansky B, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12:e41–63.
Krediet CT, van Dijk N, LinzerMvanLieshout JJ, et al. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002;106:1684–9.
van Dijk N, Quartieri F, Blanc JJ, et al. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the physical CounterpressureManoeuvres trial (PC-trial). J Am Coll Cardiol. 2006;48:1652–7.
Tomaino M, Romeo C, Vitale E, et al. Physical counter-pressure manoeuvres in preventing syncopal recurrence in patients older than 40 years with recurrent neurally mediated syncope: a controlled study from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3) dagger. Europace. 2014;16:1515–20.
Romme JJ, Reitsma JB, Black CN, et al. Drugs and pacemakers for vasovagal, carotid sinus and situational syncope. Cochrane Database Syst Rev. 2011;(10):CD004194.
Humm AM, Mason LM, Mathias CJ. Effects of water drinking on cardiovascular responses to supine exercise and on orthostatic hypotension after exercise in pure autonomic failure. J Neurol Neurosurg Psychiatry. 2008;79:1160–4.
Puvi-Rajasingham S, Smith GD, Akinola A, et al. Hypotensive and regional haemodynamic effects of exercise, fasted and after food, in human sympathetic denervation. Clin Sci (Lond). 1998;94:49–55.
Gentilcore D, Nair NS, Kuo P, et al. Effects of aerobic exercise on gastric emptying of, and the glycemic and cardiovascular responses to oral glucose in healthy older subjects. Neurogastroenterol Motil. 2008;20:83.
Kario K, Eguchi K, Nakagawa Y, et al. Relationship between extreme dippers and orthostatic hypertension in elderly hypertensive patients. Hypertension. 1998;31:77–82.
El-Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart. 1996;75:134–40.
Claydon VE, Hainsworth R. Salt supplementation improves orthostatic cerebral and peripheral vascular control in patients with syncope. Hypertension. 2004;43:809–13.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Alagiakrishnan, K. (2020). Non-pharmacological Management of Hypotensive Syndromes. In: Alagiakrishnan, K., Banach, M. (eds) Hypotensive Syndromes in Geriatric Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-30332-7_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-30332-7_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-30331-0
Online ISBN: 978-3-030-30332-7
eBook Packages: MedicineMedicine (R0)