What is the purpose of compression socks in managing orthostatic hypotension?

Purpose of Compression Socks in Managing Orthostatic Hypotension

Compression socks help manage orthostatic hypotension by reducing venous pooling in the lower extremities, thereby increasing venous return to the heart, improving cardiac output, and maintaining blood pressure upon standing. This mechanical intervention is recommended as a first-line non-pharmacological approach for orthostatic hypotension management 1.

Mechanism of Action

• Compression socks apply graduated pressure to the lower extremities (highest at the ankle, decreasing proximally)
• This compression prevents excessive venous pooling when standing
• By maintaining venous return, they help preserve cardiac output and blood pressure
• The result is reduced symptoms of orthostatic hypotension including dizziness, lightheadedness, and syncope

Effectiveness and Recommendations

Compression therapy should include the abdomen for maximum benefit, as full-length compression (lower limbs and abdomen) or abdominal compression alone are superior to knee-length or thigh-length compression 2. The European Society of Cardiology recommends thigh-high stockings with 30-40 mmHg pressure as part of first-line treatment for orthostatic hypotension 1.

Research shows that:

• Full-length compression significantly reduces the fall in systolic blood pressure after postural change 2
• Abdominal binders show superiority over compression stockings in some studies, particularly for symptom improvement 3
• Intermittent compression systems may also be beneficial in increasing mean arterial pressure and cerebral blood flow during position changes 4

Patient Compliance Challenges

Despite their effectiveness, patient compliance with compression stockings is often limited:

• Only 33% of patients wear compression stockings daily, while 43% never use them 5
• 51% of patients report difficulty with application, particularly those aged 75 or older 5
• 31% report discomfort as a reason for non-compliance 5

Optimal Use in Clinical Practice

For maximum benefit in orthostatic hypotension management:

1. Compression level: Thigh-high stockings with 30-40 mmHg pressure are recommended 1
2. Duration: Should be worn during daytime hours when upright positioning is expected
3. Combination therapy: Most effective when used alongside other non-pharmacological measures:
   • Increased fluid intake (2-3 liters daily)
   • Increased salt intake (6-9g daily)
   • Physical counterpressure maneuvers (leg crossing, squatting)
   • Positional changes (elevating head of bed 10° when sleeping)

Special Considerations

• For patients with difficulty applying compression stockings, consider:
  • Application aids
  • Lower compression levels initially
  • Alternative compression garments like abdominal binders
• For patients with heart failure, use compression therapy cautiously to avoid fluid overload 6
• For diabetic patients, ensure proper fit to avoid skin complications 6

Conclusion

Compression socks represent an important non-pharmacological intervention for orthostatic hypotension that should be considered before initiating pharmacological treatments. While they present challenges with compliance, their effectiveness in reducing orthostatic symptoms makes them a valuable component of orthostatic hypotension management.