Nonpharmacologic management of orthostatic hypotension in older people: a systematic review. The SENATOR ONTOP Series

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dc.contributor.authorSubbarayan, Selvarani
dc.contributor.authorMyint, Phyo K.
dc.contributor.authorMartin, Kathryn R.
dc.contributor.authorAbraha, Iosief
dc.contributor.authorDevkota, Sirjana
dc.contributor.authorO'Mahony, Denis
dc.contributor.authorCruz-Jentoft, Alfonso J.
dc.contributor.authorCherubini, Antonio
dc.contributor.authorSoiza, Roy L.
dc.contributor.funderSeventh Framework Programmeen
dc.date.accessioned2019-06-20T11:51:19Z
dc.date.available2019-06-20T11:51:19Z
dc.date.issued2019-05-17
dc.date.updated2019-06-20T11:44:23Z
dc.description.abstractObjectives: 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.en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationSubbarayan, 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.2019.03.032en
dc.identifier.doi10.1016/j.jamda.2019.03.032en
dc.identifier.endpage40en
dc.identifier.issn1525-8610
dc.identifier.journaltitleJournal of the American Medical Directors Associationen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8078
dc.language.isoenen
dc.publisherElsevieren
dc.relation.projectinfo:eu-repo/grantAgreement/EC/FP7::SP1::HEALTH/305930/EU/Development and clinical trials of a new Software ENgine for the Assessment & Optimization of drug and non-drug Therapy in Older peRsons/SENATORen
dc.relation.urihttp://www.sciencedirect.com/science/article/pii/S1525861019303275
dc.rights© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 licenseen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectOrthostatic hypotensionen
dc.subjectPostural hypotensionen
dc.subjectOrthostasisen
dc.subjectNonpharmacologic therapyen
dc.subjectOlder peopleen
dc.titleNonpharmacologic management of orthostatic hypotension in older people: a systematic review. The SENATOR ONTOP Seriesen
dc.typeArticle (peer-reviewed)en
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