From the Research
For postural hypotension, compression stockings with a pressure of 30-40 mmHg are typically recommended. These higher-pressure stockings provide sufficient compression to prevent blood pooling in the lower extremities when changing positions. Start by wearing them in the morning before getting out of bed, as this is when orthostatic symptoms are often most pronounced. The stockings should extend to at least knee height, though thigh-high or waist-high options may provide better results for severe cases. Proper fit is crucial - too loose and they won't be effective, too tight and they may cause discomfort or circulation problems. The compression works by applying graduated pressure (strongest at the ankle, decreasing upward) which helps push blood back toward the heart, maintaining blood pressure when standing.
Some key points to consider when using compression stockings for postural hypotension include:
- The use of full-length compression (lower limbs and abdomen) and compression of solely the abdomen have been found to be superior to knee-length and thigh-length compression in reducing the fall in systolic blood pressure after postural change 1.
- Compression therapy can be considered when other interventions fail to ameliorate symptoms, and it is essential to include the abdomen in the compression treatment as it has the greatest beneficial effect 1.
- Patient compliance with compression stockings can be limited by issues related to practicality, such as difficulty in application and discomfort, particularly in older patients 2.
- Physicians should be aware of these potential issues and work with patients to find a suitable compression stocking solution that balances effectiveness with comfort and practicality.
For best results, combine compression stockings with other strategies like slow position changes, adequate hydration, and salt intake as medically appropriate. If symptoms persist despite using compression stockings, consult a healthcare provider as medication adjustments or additional interventions may be necessary. According to a recent study, the existing compression products do not fully meet the needs of individuals with postural orthostatic tachycardia syndrome (POTS) or neurogenic orthostatic hypotension (nOH), highlighting the need for novel adjustable abdominal compression garments that are low-profile and comfortable 3.