Nondrug treatment for orthostatic hypotension

Biaggioni, 2018May, 2011Newton, 2018Palma, 2020Shen, 2017Smeenk, 2014

Nondrug measures are the mainstay of treatment for orthostatic hypotension. Nondrug treatment involves investing time in patient or carer education, with the goal of alleviating symptoms and reducing risk of falls.

Although complete resolution of orthostatic hypotension may not be achievable, significant improvement can be seen with the following measures:

  • avoiding hot environments and prolonged sitting or standing
  • changing postures slowly (eg standing gradually after prolonged sitting)
  • stopping or reducing the dose of exacerbating drugs, or changing the timing of drug doses (so they are not taken at the same time) if taking 2 or more exacerbating drugs
  • leg-tensing and leg-crossing manoeuvres when sitting or standing
  • avoiding alcohol, especially in the first half of the day
  • drinking most of the allotted daily fluid allowance in the early morning and the first half of the day
  • drinking 300 to 500 mL of water before breakfast1
  • wearing abdominal compression binders or belts when upright to compress the splanchnic veins2
  • minimising daytime bed rest
  • referral to an exercise programBonnin, 2001Mtinangi, 1999.
1 Water elicits a pressor response in the presence of autonomic impairment.Return
2 High-waist compression stockings are also effective but may not be feasible in elderly patients. Knee or thigh-high compression stockings are ineffective.Return