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:


      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.


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


      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.


      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).


      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


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      Linked Article

      • Symptom reduction in initial orthostatic hypotension: Time to get physical!
        Heart RhythmVol. 19Issue 4
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          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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