From the Research
For orthostatic hypotension, compression stockings should initially be started at 30-40 mmHg compression level, which is considered medical-grade compression. These stockings should extend to at least knee-high, though waist-high stockings may provide better control of symptoms in some patients. Start by having the patient wear them during daytime hours when they are most active and experiencing symptoms. The stockings should be put on first thing in the morning before getting out of bed, as this is when blood pooling in the lower extremities is minimal. Compression works by applying external pressure to the legs, which helps prevent blood pooling in the lower extremities and improves venous return to the heart, thereby maintaining blood pressure when changing positions. Some patients may find 20-30 mmHg compression sufficient if they cannot tolerate higher compression levels, but efficacy may be reduced. Ensure proper sizing by measuring the circumference of the ankle, calf, and thigh as needed. Patients should be advised that it may take several days to adapt to wearing compression stockings, and they should be removed at night before sleeping.
Key Considerations
- The use of compression stockings for orthostatic hypotension is supported by studies such as 1, which found that full-length compression and compression of solely the abdomen were superior to knee-length and thigh-length compression in reducing the fall in systolic blood pressure after postural change.
- Patient compliance with compression stockings can be limited by issues related to practicality, such as difficulty in application and discomfort, as reported in 2.
- The choice of compression level and stocking type should be individualized based on patient tolerance and response to treatment.
- Compression stockings are just one part of a comprehensive treatment plan for orthostatic hypotension, which may also include non-pharmacological measures such as increasing fluid and salt intake, and pharmacological treatments such as fludrocortisone, as discussed in 3 and 4.
Practical Application
- When selecting compression stockings, consider the patient's ability to apply and remove them, as well as their overall comfort and tolerance.
- Gradually introduce compression stockings to allow patients to adapt to the pressure and minimize discomfort.
- Regularly monitor patients for signs of improved orthostatic tolerance and adjust the compression level or stocking type as needed.
- Educate patients on the importance of proper sizing, application, and removal of compression stockings to ensure optimal efficacy and minimize potential complications.