Table III.
Nonpharmacologic Management of Orthostatic Hypotension/Supine Hypertension
| • Patient/provider awareness of symptoms of visual change dizziness lightheadedness to take action by sitting or lying down 1 , 20 , 25 ; patient/provider take‐home information packet available on the Internet 26 |
| • Staged standing: slow rise with intermediate sitting position 3 , 4 , 25 |
| • Physical countermaneuvers 18 , 24 , 25 , 26 : 1) upper leg crossing while sitting or standing; 2) move feet up and down at the ankle before standing; 3) gentle “marching” on the spot rather than stationary standing; 4) resting one leg in an elevated position (on a chair) while sitting or standing; 5) squatting; and 6) stooping forward when upright |
| • Avoid straining or lifting i.e., coughing or straining at stool. Valsalva compromises venous return. 18 , 25 , 26 High‐fiber diet is recommended |
| • Exercise may cause hypotension due to vasodilatation and can be encouraged but needs to be individually tailored 6 , 25 , 26 , 27 ; hydrostatic water pressure may be beneficial in swimming and pool exercises 6 , 20 , 25 |
| • Resting in the morning and postprandially (about 60 minutes) when postural symptomatology usually worsens 6 , 25 , 26 |
| • Two to 2.5 L of additional fluid daily with 10 g of salt daily 3 , 18 |
| • Elastic compression stockings to thigh level, custom fitted to achieve 30–40 mm Hg counterpressure, worn only during the day 1 , 4 , 6 , 18 , 20 ; consider an abdominal binder 6 |
| • Elevate head of bed 5–10° or 6–9 inches to reduce supine hypertension and morning exacerbation of postural symptoms due to pressure diuresis 3 , 4 , 18 , 20 , 25 , 26 |
| • Avoid excessive environmental temperatures (hot showers and baths) 6 , 25 , 26 |
| • Bedtime snack or alcohol vs. supine hypertension 18 , 19 ; avoiding drinking water within 1 hour of bedtime and midodrine within 4 hours of bedtime, also vs. supine hypertension 4 , 18 , 22 |
| • One or two cups of coffee especially with meals to reduce postprandial exacerbations 18 , 20 ; licorice 3 g daily 23 |
| • Occupational and physical therapy for ambulatory assistance to permit rapid sitting; grab aids at home; home safety evaluation 25 |