Lookup NU author(s): Dr James Frith,
Professor Julia Newton
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© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.BACKGROUND: orthostatic hypotension (OH) is highly prevalent in older populations and is associated with reduced quality of life and increased mortality. Although non-pharmacologic therapies are recommended first-line, evidence for their use is lacking. OBJECTIVE: determine the efficacy of combination non-pharmacologic therapy for OH in older people. METHODS: a total of 111 orthostatic BP responses were evaluated in this prospective phase 2 efficacy study in 37 older people (≥60 years) with OH. Primary outcome was the proportion of participants whose systolic BP drop improved by ≥10 mmHg. Secondary outcomes include standing BP and symptoms. Comparison is made to the response rate of the most efficacious single therapy (bolus water drinking 56%). Therapeutic combinations were composed of interventions with known efficacy and tolerability: Therapy A- Bolus water drinking + physical counter-manoeuvres (PCM); Therapy B- Bolus water drinking + PCM + abdominal compression. RESULTS: the response rate to therapy A was 38% (95% confidence interval - CI 24, 63), with standing systolic BP increasing by 13 mmHg (95% CI 4, 22). Therapy B was efficacious in 46% (95% CI 31, 62), increasing standing systolic BP by 20 mmHg (95% CI 12, 29). Neither therapy had a significant effect on symptoms. There were no adverse events. CONCLUSIONS: in comparison to single therapy, there is little additional benefit to be gained from combination non-pharmacologic therapy. Focussing on single, efficacious therapies, such as bolus water drinking or PCM, should become standard first-line therapy.
Author(s): Frith J, Newton JL
Publication type: Article
Publication status: Published
Journal: Age and ageing
Online publication date: 23/12/2019
Acceptance date: 19/10/2019
ISSN (print): 0002-0729
ISSN (electronic): 1468-2834
Publisher: Oxford University Press
PubMed id: 31868889
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