Data from: The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging

Objective: To determine the efficacy and safety of non-pharmacological interventions for orthostatic hypotension (OH) secondary to aging.
Methods: A total of 150 orthostatic challenges were performed in 25 older people (60-92 years) to determine cardiovascular responses to bolus-water drinking, compression stockings, abdominal compression and physical counter-manoeuvres. Primary outcome was response rate, as assessed by proportion of participants whose systolic drop improved by ≥10 mmHg.
Results: The response rate to bolus water drinking was 56% (95% confidence interval 36.7, 74.2), with standing systolic BP (SBP) increasing by 12 mmHg (95%CI 4, 20). Physical counter-manoeuvres were efficacious in 44% (95%CI 25.8, 63.3) but had little effect on standing SBP [+7.5 mmHg (95%CI -1, 16)]. Abdominal compression was efficacious in 52% (95%CI 32.9, 70.7) and improved standing SBP [+10 mmHg (95%CI 2, 8). Compression stockings were the least efficacious therapy, 32% (95%CI 16.1, 51.4) and had little effect on standing SBP [+6 mmHg (95%CI -1, 13). No intervention improved symptoms during standing. There were no adverse events.
Conclusions: Bolus water drinking should become the standard first line non-pharmacological intervention, whereas compression stockings should be disregarded in this population.
Classification of Evidence: This study provides Class III evidence that for older people with orthostatic hypotension, bolus water drinking is superior to other non-pharmacological interventions in decreasing systolic BP drop.

研究目标：明确针对衰老继发性体位性低血压（orthostatic hypotension, OH）的非药物干预措施的疗效与安全性。
研究方法：纳入25名年龄60~92岁的老年受试者，共完成150次直立位激发试验，以评估一次性大量饮水、加压弹力袜、腹部加压及身体对抗动作四种非药物干预的心血管反应。主要结局指标为有效率，即收缩压下降幅度≥10mmHg的受试者占比。
研究结果：一次性大量饮水的有效率为56%（95%置信区间36.7~74.2），受试者站立位收缩压（SBP）升高12mmHg（95%CI 4~20）。身体对抗动作的有效率为44%（95%CI 25.8~63.3），但对站立位收缩压影响甚微[升高7.5mmHg（95%CI -1~16）]。腹部加压的有效率为52%（95%CI 32.9~70.7），可改善站立位收缩压[升高10mmHg（95%CI 2~8）]。加压弹力袜的疗效最差，有效率为32%（95%CI 16.1~51.4），对站立位收缩压影响极小[升高6mmHg（95%CI -1~13）]。所有干预措施均未改善直立位相关症状，且未出现不良事件。
研究结论：一次性大量饮水应作为该人群的标准一线非药物干预措施，而加压弹力袜则不应被选用。
证据分级：本研究提供III级证据，表明对于合并体位性低血压的老年人群，一次性大量饮水在降低收缩压下降幅度方面优于其他非药物干预措施。