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Clinical General| Volume 19, ISSUE 4, P604-610, April 2022

Lower body muscle preactivation and tensing mitigate symptoms of initial orthostatic hypotension in young females

Published:February 08, 2022DOI:https://doi.org/10.1016/j.hrthm.2021.12.030
Lower body muscle preactivation and tensing mitigate symptoms of initial orthostatic hypotension in young females
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      Background

      Initial orthostatic hypotension (IOH) is a form of orthostatic intolerance defined by a transient decrease in blood pressure upon standing. Current clinical recommendations for managing IOH includes standing up slowly or lower body muscle tensing (TENSE) after standing. Considering that IOH is likely due to a large muscle activation response resulting in excessive vasodilation with a refractory period (<2 minutes), we hypothesized that preactivating lower body muscles (PREACT) before standing would reduce the drop in mean arterial pressure (MAP) upon standing and improve presyncope symptoms.

      Objective

      The purpose of this study was to provide IOH patients with effective symptom management techniques.

      Methods

      Study participants completed 3 sit-to-stand maneuvers, including a stand with no intervention (Control), PREACT, and TENSE. Continuous heart rate and beat-to-beat blood pressure were measured. Stroke volume and cardiac output were then estimated from these waveforms.

      Results

      A total of 24 female IOH participants (mean ± SD: 32 ± 8 years) completed the study. The drops in MAP following PREACT (–21 ± 8 mm Hg; P <.001) and TENSE (–18 ± 10 mm Hg; P <.001) were significantly reduced compared to Control (–28 ± 10 mm Hg). The increase in cardiac output was significantly larger following PREACT (2.6 ± 1 L/min; P <.001) but not TENSE (1.9 ± 1 L/min; P = .2) compared to Control (1.4 ± 1 L/min). The Vanderbilt Orthostatic Symptom Score following PREACT (9 ± 8 au; P = .033) and TENSE (8 ± 8 au; P = .046) both were significantly reduced compared to Control (14 ± 9 au).

      Conclusion

      Both the drop in MAP and symptoms upon standing improved with either PREACT or TENSE. These maneuvers provide novel symptom management techniques for patients with IOH.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Keywords

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      Article info

      Publication history

      Published online: February 08, 2022

      Footnotes

      Funding Sources: This work was supported by funding Dr Raj receives from the Canadian Institutes of Health Research (CIHR; Ottawa, ON, Canada) Grant MOP142426 and support from the Vanderbilt Institute for Clinical and Translational Research (NIH UL1-TR000445; Bethesda, MD, USA). Disclosures: Dr Exner has served as a consultant for Abbott Medical, Medtronic Inc, and GE Healthcare; and is a minority shareholder in Analytics for Life and HelpWear. Dr Phillips holds various patents related to blood pressure measurement and neuromodulation, some of which are licensed to industry; is a shareholder of ONWARD Medical and is on the medical advisory board; and is founder and shareholder of StimSherpa. Dr Raj has served as a consultant for Lundbeck NA Ltd., Theravance Biopharma, Medscape, Academy for Continued Healthcare Learning, and Sprire Learning; as chair of the Data Safety and Monitoring Board for Arena Pharmaceuticals; and as associate editor of Autonomic Neurosciences and on the Medical Advisory Board of Dysautonomia International and PoTS UK, both without financial compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. ClinicalTrials.gov Identifier: NCT03970551.

      Identification

      DOI: https://doi.org/10.1016/j.hrthm.2021.12.030

      Copyright

      © 2021 Heart Rhythm Society. All rights reserved.

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      Linked Article

      • Symptom reduction in initial orthostatic hypotension: Time to get physical!
        Heart RhythmVol. 19Issue 4
        • Preview
          Symptoms of initial orthostatic hypotension are common in the general population and are related to a short period of cerebral hypoperfusion due to a transient fall in the systemic blood pressure.1 In 2011, the American Autonomic Society consensus statement included a spectrum of abnormal circulatory responses, differentiating initial orthostatic hypotension, delayed orthostatic hypotension, and classic orthostatic hypotension.2 Initial orthostatic hypotension was defined as an immediate and transient drop in blood pressure within 15 seconds of standing of > 40 mm Hg in systolic blood pressure and/or >20 mm Hg in diastolic blood pressure.
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