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Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotensionOrthostatic hypotension (OH) is the most disabling and serious manifestation of adrenergic failure, occurring in the autonomic neuropathies, pure autonomic failure (PAF) and multiple system atrophy (MSA). No specific treatment is currently available for most etiologies of OH. A reduction in venous capacity, secondary to some physical counter maneuvers (e.g., squatting or leg crossing), or the use of compressive garments, can ameliorate OH. However, there is little information on the differential efficacy, or the mechanisms of improvement, engendered by compression of specific capacitance beds. We therefore evaluated the efficacy of compression of specific compartments (calves, thighs, low abdomen, calves and thighs, and all compartments combined), using a modified antigravity suit, on the end-points of orthostatic blood pressure, and symptoms of orthostatic intolerance. Fourteen patients (PAF, n = 9; MSA, n = 3; diabetic autonomic neuropathy, n = 2; five males and nine females) with clinical OH were studied. The mean age was 62 years (range 31-78). The mean +/- SEM orthostatic systolic blood pressure when all compartments were compressed was 115.9 +/- 7.4 mmHg, significantly improved (p < 0.001) over the head-up tilt value without compression of 89.6 +/- 7.0 mmHg. The abdomen was the only single compartment whose compression significantly reduced OH (p < 0.005). There was a significant increase of peripheral resistance index (PRI) with compression of abdomen (p < 0.001) or all compartments (p < 0.001); end-diastolic index and cardiac index did not change. We conclude that denervation increases vascular capacity, and that venous compression improves OH by reducing this capacity and increasing PRI. Compression of all compartments is the most efficacious, followed by abdominal compression, whereas leg compression alone was less effective, presumably reflecting the large capacity of the abdomen relative to the legs.
Document ID
20040172797
Acquisition Source
Legacy CDMS
Document Type
Reprint (Version printed in journal)
Authors
Denq, J. C.
(National Defense Medical Center, Tri-Service General Hospital Taipei, Republic of China)
Opfer-Gehrking, T. L.
Giuliani, M.
Felten, J.
Convertino, V. A.
Low, P. A.
Date Acquired
August 22, 2013
Publication Date
December 1, 1997
Publication Information
Publication: Clinical autonomic research : official journal of the Clinical Autonomic Research Society
Volume: 7
Issue: 6
ISSN: 0959-9851
Subject Category
Aerospace Medicine
Funding Number(s)
CONTRACT_GRANT: PO1 NS32352
Distribution Limits
Public
Copyright
Other
Keywords
Non-NASA Center
Clinical Trial
NASA Discipline Cardiopulmonary
Randomized Controlled Trial

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