Nonpharmacologic management of orthostatic hypotension in older people: a systematic review. The SENATOR ONTOP Series
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Date
2019-05-17
Authors
Subbarayan, Selvarani
Myint, Phyo K.
Martin, Kathryn R.
Abraha, Iosief
Devkota, Sirjana
O'Mahony, Denis
Cruz-Jentoft, Alfonso J.
Cherubini, Antonio
Soiza, Roy L.
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Published Version
Abstract
Objectives: Nonpharmacologic therapies are often recommended as a first-line treatment for orthostatic hypotension (OH). However, the true effect of nonpharmacologic therapy remains unclear, particularly in the older population. We undertook a systematic review evaluating the efficacy of nonpharmacologic interventions in older people with OH to provide evidence-based recommendations. Design: Systematic review of systematic reviews. Setting and Participants: MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews, CINHAL, and PsycINFO were searched up to June 2018. Two reviewers identified eligible systematic reviews from which primary studies were selected. We included both randomized and nonrandomized studies that evaluated any type of nonpharmacologic intervention and reported outcomes of change in postural drop in systolic blood pressure (SBP) and/or orthostatic symptoms measured using any validated instrument. The Cochrane risk of bias tool was used, with recommendations based on the GRADE approach. Results: Eleven trials were included. Meta-analysis of lower limb compression showed a reduction in the postural drop in SBP of 9.83 mmHg [95% confidence interval (CI) −12.56, −7.11], whereas abdominal compression showed a larger reduction in postural drop in SBP of 12.30 mmHg (95% CI –18.20, −6.39). Compression therapy was also beneficial in reducing OH symptoms. However, the quality of the evidence for compression therapy was very poor. One study each was identified for sleeping with head-up (SHU), home-based resistance training (HBRT), and multicomponent intervention but did not significantly reduce postural SBP drop. Bolus water drinking was effective in 1 study but the study was of low quality. Conclusions/Implications: There is no high-quality evidence to recommend any of the nonpharmacologic therapies for the management of OH in older people. Yet, we make a weak recommendation for lower limb and abdominal compression therapy based on very low quality evidence. Large-scale trials are warranted in older people to substantiate the efficacy of nonpharmacologic therapies in OH.
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Keywords
Orthostatic hypotension , Postural hypotension , Orthostasis , Nonpharmacologic therapy , Older people
Citation
Subbarayan, S., Myint, P. K., Martin, K. R., Abraha, I., Devkota, S., O'Mahony, D., Cruz-Jentoft, A. J., Cherubini, A. and Soiza, R. L. (2019) 'Nonpharmacologic Management of Orthostatic Hypotension in Older People: A Systematic Review. The SENATOR ONTOP Series', Journal of the American Medical Directors Association, In Press. doi: 10.1016/j.jamda.2019.03.032