Reader response: The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging

I read with interest the nonpharmacologic manipulations for management of orthostatic hypotension (OH) detailed by Drs. Newton and Frith.¹ Regardless of guidelines,² OH is clinically meaningless in the absence of regular or inevitable syncope, as systolic blood pressure (SBP), syncope, and cerebral arteriosclerosis do not necessarily run pari passu. While fall in SBP is a part of the guidelines, it is the diastolic blood pressure (DBP) that determines steady cerebral blood flow. A total of 480 mL tap water consumed within 5 minutes will neither be fully absorbed by the gastrointestinal system nor will be retained fully by the renal tubular system. No wonder only 56% of participants of a tiny cohort responded with a modest rise in SBP while DBP remained unaffected.¹ While standing cross-legged is truly enigmatic, will abdominal compression and elastic stockings improve or worsen venous return in uncomplicated hypotensive nonobese elderly?

from Neurology recent issues https://ift.tt/2FPtCfB