From the Guidelines
Salt tablets can be a useful adjunct in managing orthostatic hypotension, particularly when combined with increased fluid intake, as they help expand blood volume and maintain blood pressure when changing positions. According to the most recent and highest quality study 1, increased salt and fluid intake may be beneficial in selected patients with neurogenic orthostatic hypotension. The study suggests that salt supplementation, such as 6 to 9 grams (100 to 150 mmol) of salt per day, can increase plasma volume and improve blood pressure. However, it is essential to use salt tablets cautiously in people with heart failure, kidney disease, or hypertension, as excessive sodium can worsen these conditions.
Some key points to consider when using salt tablets for orthostatic hypotension include:
- Starting with a lower dose and gradually increasing it while monitoring blood pressure response
- Combining salt tablets with adequate fluid intake (2-3 liters daily) for optimal effectiveness
- Using salt tablets in conjunction with other strategies, such as compression stockings, slow position changes, and small frequent meals to avoid post-prandial hypotension
- Consulting with a healthcare provider to determine the optimal dosage and ensure that salt tablets are appropriate for the individual's specific situation
It is also important to note that other medications, such as fludrocortisone, midodrine, and droxidopa, may be used to manage orthostatic hypotension, but they may be poorly tolerated in patients with heart failure or cardiac involvement 1. Pyridostigmine is another option for orthostatic hypotension that may be better tolerated in these patients. Ultimately, the decision to use salt tablets or other treatments for orthostatic hypotension should be made in consultation with a healthcare provider, taking into account the individual's specific needs and medical history.
From the Research
Management of Orthostatic Hypotension
- Orthostatic hypotension is a decline in blood pressure that occurs when moving from a lying to a standing position, resulting in symptoms of cerebral hypoperfusion, such as lightheadedness and syncope 2.
- Nonpharmacologic approaches are preferred and include increasing sodium intake, avoiding rapid postural changes, and wearing elastic garments 2, 3.
- Increasing dietary salt intake is often recommended to improve orthostatic tolerance, although there is no empirical evidence to support this recommendation in orthostatic hypotension 4.
Role of Salt Tablets
- Salt tablets are not explicitly mentioned as a treatment for orthostatic hypotension in the provided studies.
- However, increasing dietary salt intake is discussed as a potential method to improve orthostatic tolerance 4.
- One study found that ingesting salt water paradoxically attenuated the pressor response to water in patients with orthostatic hypotension, suggesting that salt may not be as effective as previously thought 5.
Alternative Treatments
- Fludrocortisone acetate is often used to treat orthostatic hypotension, although it should be used with caution in patients with congestive heart failure 2, 6.
- Midodrine, a sympathathomimetic amine, has also been used to treat orthostatic hypotension 3, 6.
- Other treatments, such as increasing fluid intake, wearing compression stockings, and elevating the head of the bed, may also be effective in managing orthostatic hypotension 3, 6.