Two free, non-drug treatments can improve a patient’s quality of life


Feeling dizzy upon standing up due to initial orthostatic hypotension (IOH), or a transient decrease in blood pressure and increase in heart rate, is a common but poorly understood condition. A new study offers two simple, drug-free techniques to effectively manage HOI symptoms and improve quality of life by activating lower body muscles before or after standing. The search appears in Heartbeatthe official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society and the Pediatric & Congenital Electrophysiology Society, published by Elsevier.

Syncope, dizziness, lightheadedness, or loss of consciousness due to HOI affects up to 40% of the general population (all ages), while presyncope is probably even more common. Despite this, the condition is relatively understudied and there is little information available on the underlying mechanisms or the management and treatment of symptoms. Currently, there are very few options available for patients with IOH and no pharmacological treatment. The most common recommendations were to get up slowly or sit down before getting up.

“Almost everyone has probably felt dizzy at some point after standing up,” explained lead researcher Satish R. Raj, MD, MSCI, FHRS, Professor of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine , University of Calgary, Calgary, AB, Canada. “For some people, this happens frequently and can happen several times a day, which can be very scary and negatively impact their quality of life. We wanted to explore this further and provide novel symptom management techniques. and effective in order to improve the quality of life of IOH patients.”

This study examined physical maneuvers before or after standing and their effectiveness in reducing the drop in blood pressure as well as the symptoms commonly seen in IOH patients while standing. Study participants included 24 young women (mean age 32 ± 8 years) with a heavy history of fainting immediately after standing and more than four episodes of presyncope or syncope per month. Study participants had to have a significant drop in systolic blood pressure of at least 40 mmHg while standing to meet the diagnostic criteria for HOI on the day of the study. Two participants had inadequate heart rate recordings and were excluded from the analysis.

The 22 study participants performed three sit-to-stand maneuvers, including one standing without intervention (control) and two interventions. Researchers found that preactivating lower body muscles (thighs) by repeated knee raises before standing (PREACT) and tensing lower body muscles (thighs and buttocks) by crossing legs and tension immediately after standing (TENSE) effectively improve blood pressure drop. This led to a reduction in symptoms when standing. They found that the PREACT maneuver accomplished this by increasing cardiac output, while the TENSE maneuver did this by increasing stroke volume.

“Our study provides a novel and cost-free symptom management technique that patients with HOI can use to manage their symptoms,” noted first author Nasia A. Sheikh, MSc, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. “Since it is a physical maneuver, it simply requires the lower limbs of the body, which patients can use anytime and anywhere to combat their symptoms.”

“Our study demonstrates the physiology of IOH and assesses the usefulness of physical maneuvers that can help the IOH patient manage their symptoms. A diagnosis of IOH is identified by patients as the essential first step in enabling them to understand and control their symptoms and thus minimize disruptions to daily life caused by this common, but not commonly understood condition,” added co-investigator Mary Runté, PhD, University of Lethbridge, Lethbridge, AB, Canada.

In an accompanying editorial, Bert Vandenberk, MD, PhD, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; and Carlos A. Morillo, MD, FHRS, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, said “PREACT and TENSE offer an elegant and simple option for effective relief symptoms for patients with IOH.” However, they noted, “The study needs to be validated in men, as well as explored in the elderly where multiple confounding factors need to be addressed. Understanding the role of cardiopulmonary mechanoreceptors should also provide further mechanistic insights into the effects of these simple but highly effective physiological maneuvers.

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Material provided by Elsevier. Note: Content may be edited for style and length.


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