Efficacy of Servo-Controlled Splanchnic Venous Compression in the Treatment of Orthostatic Hypotension

Abstract

Splanchnic venous pooling is a major hemodynamic determinant of orthostatic hypotension (OH), but is not specifically targeted by pressor agents, the mainstay of treatment. We developed an automated inflatable abdominal binder that provides sustained servo-controlled venous compression (40 mmHg) and can be activated only on standing. We tested the efficacy of this device against placebo and compared it to midodrine in nineteen autonomic failure patients randomized to receive either placebo, midodrine (2.5–10 mg) or placebo combined with binder on separate days in a single-blind, crossover study. Systolic blood pressure (SBP) was measured seated and standing before and 1-hour post-medication; the binder was inflated immediately before standing. Only midodrine increased seated SBP (31±5 vs. 9±4 placebo and 7±5 binder, P=0.003); whereas orthostatic tolerance (defined as area under the curve of upright SBP [AUCSBP]) improved similarly with binder and midodrine (AUCSBP, 195±35 and 197±41 vs. 19±38 mmHg*min for placebo, P=0.003). Orthostatic symptom burden decreased with the binder (from 21.9±3.6 to 16.3±3.1, P=0.032) and midodrine (from 25.6±3.4 to 14.2±3.3, P<0.001), but not with placebo (from 19.6±3.5 to 20.1±3.3, P=0.756). We also compared the combination of midodrine and binder, with midodrine alone. The combination produced a greater increase in orthostatic tolerance (AUCSBP, 326±65 vs. 140±53 mmHg*min for midodrine alone, P=0.028, n=21), and decreased orthostatic symptoms (from 21.8±3.2 to 12.9±2.9, P<0.001). In conclusion, servo-controlled abdominal venous compression with an automated inflatable binder is as effective as midodrine, the standard of care, in the management of OH. Combining both therapies produces greater improvement in orthostatic tolerance.

Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection

“…However, a standard leg compression bandage may reduce postural hypotension and symptoms at mobilization, as shown in a heterogeneous cohort of hospitalized nonsurgical patients with various acute conditions . Furthermore, wearing an automated inflatable abdominal binder may improve orthostatic competence in nonsurgical patients with orthostatic hypotension, and with the same effect as midodrine alone …”

Epidemiology, Diagnosis, and Management of Neurogenic Orthostatic Hypotension

“…Elastic abdominal binders are a good alternative . An abdominal binder that was developed inflates automatically only on standing and provides sustained splanchnic venous compression (40 mm Hg), and it showed promising results in patients with nOH …”

“…50,51 An abdominal binder that was developed inflates automatically only on standing and provides sustained splanchnic venous compression (40 mm Hg), and it showed promising results in patients with nOH. 52 Sleep with the Head of the Bed Raised Supine hypertension (SH) is frequent in patients with nOH. It is a side effect of antihypotensive treatment but it also occurs in untreated patients.…”

Homeostatic systems, biocybernetics, and autonomic neuroscience

“…Many examples of allostatic load in experimental animals as well as in humans involve the effects of repeated episodes or chronic duration of stress in which brain activation of neuroendocrine functions plays a key role. (McEwen, 2016). …”

“…Carotid sinus stimulation or renal sympathetic radiofrequency ablation may attenuate refractory hypertension (Krum et al, 2009; Lohmeier et al, 2011). Intravenous infusion of norepinephrine or an automated abdominal binder may mitigate neurogenic orthostatic hypotension (Goldstein et al, 2012; Okamoto et al, 2016; Polinsky et al, 1983; Zekeridou et al, 2015); and vagus nerve stimulation, by directly or reflexively evoking effects on elaboration of cytokines, may be useful to treat conditions involving auto-immunity such as rheumatoid arthritis (Koopman et al, 2016). …”