From the Guidelines
Nonpharmacologic management of orthostatic hypotension should prioritize lifestyle modifications, including increasing fluid intake to 2-3 liters daily and salt consumption to 10g per day, as well as physical techniques like elevating the head of the bed and using compression garments. According to the most recent guidelines 1, the therapeutic goal is to minimize postural symptoms rather than to restore normotension, and nonpharmacologic measures play a crucial role in achieving this goal.
Some key strategies for managing orthostatic hypotension include:
- Increasing fluid intake to 2-3 liters daily and salt consumption to 10g per day to expand blood volume 1
- Elevating the head of the bed by 4-6 inches to reduce nocturnal diuresis and morning hypotension 1
- Using compression garments like waist-high stockings or abdominal binders to improve venous return 1
- Encouraging physical countermaneuvers such as crossing legs while standing, squatting, or tensing lower body muscles to temporarily raise blood pressure during symptomatic episodes 1
- Avoiding triggers like hot environments, large meals, alcohol consumption, and prolonged standing 1
- Eating small, frequent meals to minimize postprandial hypotension 1
- Engaging in regular, moderate exercise focusing on leg and core strengthening to improve vascular tone and orthostatic tolerance 1
These strategies work by increasing blood volume, reducing venous pooling, and enhancing compensatory mechanisms to maintain cerebral perfusion when changing positions. By prioritizing these nonpharmacologic measures, patients with orthostatic hypotension can effectively manage their symptoms and improve their quality of life.
From the Research
Nonpharmacologic Management Strategies for Orthostatic Hypotension
Nonpharmacologic strategies for managing orthostatic hypotension include:
- Dietary modifications 2, 3
- Compression garments 2
- Physical maneuvers 2, 3
- Avoiding environments that exacerbate symptoms 2
- Lifestyle modifications 4
- Physical countermaneuvers 4, 3
- Water bolus treatment 3
- Patient education and a patient-orientated approach to management 3
- Preventive measures, such as patient and caregiver education 5
- Nonpharmacologic approaches to treatment, including behavioral strategies 6
Specific Nonpharmacologic Interventions
Some specific nonpharmacologic interventions that may be useful in managing orthostatic hypotension include:
- Increasing fluid and salt intake to expand blood volume 3
- Avoiding standing for long periods or standing up quickly 2
- Elevating the head of the bed to reduce supine hypertension 3
- Using compression stockings or abdominal binders to reduce venous pooling 2, 3
- Performing physical countermaneuvers, such as leg crossing or ankle contractions, to increase blood pressure 4, 3