Seating-Induced Postural Hypotension Is Common in Older Patients with Decompensated Heart Failure and May Be Prevented by Lower Limb Compression Bandaging

Abstract

Background: Postural hypotension induced by transition from supine to sitting position and measures for its prevention in heart failure has not been investigated. Objective: Our purpose was to evaluate the prevalence of postural hypotension and associated clinical manifestations as well as the contribution of various risk factors for postural hypotension on transition from lying to sitting in older patients with decompensated heart failure, and to study the eventual preventive effect of leg bandaging. Methods: Seating-induced postural hypotension (≥20 mm Hg systolic and/or ≥10 mm Hg diastolic blood pressure fall) was assessed on the first study day in 108 patients aged ≥60 years, hospitalized for acutely decompensated heart failure. On the next day, in patients manifesting postural hypotension, compression bandages were applied along both legs before seating. Blood pressure, heart rate, O₂ saturation, and the occurrence of dizziness or palpitations were recorded prior to and 1, 3 and 5 min following seating. Results: Postural hypotension occurred in 49.1% of patients. Dizziness and/or palpitations manifested in 25%. Diastolic (36.1%) versus systolic (23.1%) postural hypotension prevailed (p = 0.05). On univariate analysis, postural hypotension was associated with female sex (p = 0.03), more severe heart failure (p = 0.05), longer bedrest (p = 0.04), higher supine systolic (p = 0.01) or diastolic (p = 0.002) blood pressure, nonischemic heart failure (p = 0.002), and not using nitrates (p = 0.01). On multivariate analysis, longer bedrest (OR = 1.58, 95% CI = 1.13–2.2, p < 0.001), higher supine diastolic blood pressure (OR = 1.33, 95% CI = 1.1–1.61, p = 0.001), and nonischemic heart failure (OR = 3.48, 95% CI = 1.4–8.63, p = 0.009) were the most predictive of postural hypotension. Compression bandages prevented postural hypotension in 21 of 49 patients and decreased the degree of postural blood pressure fall (p < 0.001). Conclusion: Seating-induced postural hypotension is common among older inpatients with decompensated heart failure, especially with longer bedrest, higher supine diastolic blood pressure and non-ischemic etiology. Leg compression bandaging may be useful for the prevention of postural hypotension in these patients.

Assessment of effects of differences in trunk posture during Fowler&rsquo;s position on hemodynamics and cardiovascular regulation in older and younger subjects

“…An upright upper trunk in Fowler’s position might help to reduce orthostatic stress and facilitate routine activities and conversation in frail patients. Some studies have suggested that leg compression bandaging could prevent orthostatic hypotension in older patients 2,38. Although that method might indeed be effective, that approach requires a more time-consuming procedure and the patient may feel a sense of uncomfortable restriction from the bandaging.…”

Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project)

“…Parkinson's disease, multiple system atrophy, or autonomic neuropathies), 25 frail elderly patients 3,26,27 and chronic heart failure. 9,28,29 Furthermore, both hypertension 30–32 and diabetes 33,34 have been related to impaired orthostatic homeostasis through mechanisms, which are not yet completely understood. In such high-risk settings, OH demonstrates higher prevalence than in the general population, suggesting a multifactorial aetiology of postural haemodynamic failure.…”

Non-pharmacological management of orthostatic hypotension in the older patient

“…Gorelick et al applied compression bandages at pressures of 40 mmHg to the lower limbs in 49 older heart failure patients (mean age 75 years). 81 Postural drop and symptoms were evaluated on standing on two separate occasions. On one occasion, sham bandages were applied (3 mmHg pressure), while on a separate occasion active compression bandages were applied with a pressure of 40 mmHg.…”