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Lower Limb and Abdominal Compression Bandages Prevent Progressive Orthostatic Hypotension in Elderly Persons

A Randomized Single-Blind Controlled Study

Cristian Podoleanu, MD^_*, Roberto Maggi, MD, Michele Brignole, MD^,_*, Francesco Croci, MD, Alexander Incze, MD^_*, Alberto Solano, MD, Enrico Puggioni, MD and Emilian Carasca, MD^_*

^_* Cardiologie–Clinica Medicala 4, Spitalul Clinic de Urgenta, University Hospital, Targu Mures, Romania
Department of Cardiology and Arrhythmologic Center, Ospedali del Tigullio, Lavagna, Italy

View larger version (18K): [in a new window]   Figure 1 Case patient. From top to bottom are shown heart rate (HR) curve and blood pressure (BP) curves (systolic and diastolic). The arrows indicate the passage from supine to standing and vice versa. (Left panel) Inactive sham treatment. There is an absence of adaptation of blood pressure to the upright position. Blood pressure declines slightly and progressively throughout the test. Systolic blood pressure declines below 80 mm Hg for 6 min, and the patient has severe presyncopal symptoms. Heart rate continuously increases until the end of the test. There is no clear vasovagal reaction. (Right panel) Active treatment. There is a slight decrease in blood pressure and a heart rate increase immediately after standing, then these parameters stabilize all along the treatment period.

View larger version (13K): [in a new window]   Figure 2 Case patient. From top to bottom are shown heart rate (HR) curve and blood pressure (BP) curves (systolic and diastolic). The arrows indicate the passage from supine to standing and vice versa. (Left panel) Inactive sham treatment. There is an absence of adaptation of blood pressure to the upright position. Blood pressure progressively declines throughout the test; after 8 min there is a sudden decrease in blood pressure. After an initial slight increase, heart rate also declines. The patient becomes syncopal. The decrease in heart rate in association with blood pressure decrease suggests a late activation of a vagal reflex, which is triggered by the initial dysautonomia. Thus the mechanism producing reflex syncope seems to be different from that of the typical vasovagal reaction usually observed in younger subjects. (Right panel) Active treatment. There is a slight decrease in all parameters after standing, then they stabilize all along the treatment period.

View larger version (22K): [in a new window]   Figure 3 Patient case. From top to bottom are shown heart rate (HR) curve and blood pressure (BP) curves (systolic and diastolic). The arrows indicate the passage from supine to standing and vice versa. (Left panel) Inactive sham treatment. There is an absence of adaptation of blood pressure to the upright position. Blood pressure declines slightly and progressively throughout the test. Systolic blood pressure declines below 80 mm Hg. Heart rate remains stable at about 50 beats/min (chronotropic incompetence pattern). (Right panel) Active treatment. Treatment increases blood pressure during the test. Heart rate remains stable at about 50 beats/min (chronotropic incompetence pattern).

View larger version (119K): [in a new window]   Figure 4 Elastic bandage of the leg and the abdomen during acute tilt study.

View larger version (150K): [in a new window]   Figure 5 Elastic stocking therapy during the follow-up.

View larger version (18K): [in a new window]   Figure 6 (A, B) Acute tilt-table study results. Systolic blood pressure (A) and heart rate (B) in the active treatment arm (continuous line) and control arm (dotted line). Values are expressed as mean ± 1 SE. During the test, some patients had syncope and the test was interrupted; numbers at the top refer to patients free of syncope at that time. (A) With inactive sham treatment there was a progressive decrease in systolic blood pressure all along the test; on the contrary, after a mild decrease from supine to standing, bandage maintained pressure at a stable level all along the test. The difference became significant (p < 0.05) from the fourth minute to the end of the test. The small nonsignificant higher value of blood pressure in the supine position in the active treatment arm is likely to be caused by an effect of an elastic bandage already present in the supine position. (B) Heart rate behavior was similar in the 2 study arms. There was a progressive compensatory heart rate increase all along the test of similar entity with both treatments. HR = heart rate; SBP = systolic blood pressure.

View larger version (17K): [in a new window]   Figure 7 (A, B) Evaluation of the effect of the two sequences of randomization and the treatment–period interaction (carryover effect) on decrease in systolic blood pressure (with standard error of the mean bars) during leg bandage (A) and leg plus abdomen bandage (B). SBP = systolic blood pressure.

View larger version (16K): [in a new window]   Figure 8 Relative weight of the 7 items that form the Specific Symptom Scale Questionnaire for Orthostatic Intolerance (SSS-OI) total score in patients at baseline.