From the Guidelines
Non-pharmacological management strategies for orthostatic hypotension (OH) should prioritize physical counter-pressure maneuvers, compression garments, and adequate hydration to reduce symptoms and improve quality of life. According to the most recent and highest quality study 1, physical counter-pressure maneuvers such as leg crossing, lower body muscle tensing, and maximal force handgrip can increase blood pressure and improve orthostatic tolerance. Compression garments, specifically those that are at least thigh high and include the abdomen, can also improve orthostatic symptoms and blunt associated decreases in blood pressure 1.
Some key strategies for managing OH include:
- Physical counter-pressure maneuvers: leg crossing, lower body muscle tensing, and maximal force handgrip
- Compression garments: at least thigh high and include the abdomen
- Adequate hydration: consuming ≥240 mL of water to temporarily restore orthostatic tolerance, with the peak effect occurring 30 minutes after ingestion 1
- Avoiding rapid position changes and elevating the head of the bed by 4-6 inches to reduce nocturnal diuresis
- Small, frequent meals to avoid postprandial hypotension
- Avoiding alcohol, hot environments, and prolonged standing
These strategies can help increase blood volume, enhance venous return, reduce venous pooling, and improve cardiovascular conditioning, ultimately maintaining blood pressure upon standing. While other studies, such as 1, provide additional guidance on lifestyle modifications and volume expansion, the most recent and highest quality study 1 prioritizes physical counter-pressure maneuvers, compression garments, and adequate hydration as the primary non-pharmacological management strategies for OH.
From the Research
Non-Pharmacological Management Strategies for Orthostatic Hypotension (OH)
The non-pharmacological approach to managing OH is aimed at optimizing blood volume, decreasing postural venous pooling, reducing heat and post-prandial induced vasodilation, emphasizing physical conditioning, and minimizing nocturnal diuresis 2. This approach may include:
- Reviewing and modifying medications that may aggravate or cause OH
- Implementing lifestyle measures such as counterpressure maneuvers
- Adopting physical conditioning and exercise routines
- Managing fluid and electrolyte balance
- Avoiding factors that exacerbate OH, such as heat and large meals
Key Components of Non-Pharmacological Management
Education of the patient and non-pharmacological measures are cornerstones of OH treatment 3, 4. These measures may include:
- Patient education on the nature of the underlying disorder and reversible causes of OH
- Counseling on lifestyle modifications and self-management techniques
- Physical countermaneuvers to improve blood flow and reduce symptoms
- Fluid repletion and electrolyte management to optimize blood volume
Individualized Approach to Management
The management of OH should be individualized according to the severity, underlying cause, and associated coexisting conditions 3, 4. A stepwise approach to management may be necessary, with non-pharmacological measures being the first line of treatment, followed by pharmacological interventions as needed.