BACKGROUND: the evidence for 6-inch tilt sleeping-head-up (SHU), a common therapy for the treatment of orthostatic hypotension (OH) in older people, is unavailable. OBJECTIVE: to investigate the effects of 6-inch SHU for 6 weeks in community-living patients with chronic OH. DESIGN: open labelled randomised controlled trial. METHODS: one hundred patients aged ≥60 withchronic OH were randomised into SHU or control groups. Primary outcome measures were mean arterial pressure (MAP) and symptoms. Repeated measures of orthostatic haemodynamic parameters (systolic blood pressure, diastolic blood pressure, MAP, heart rate, percentage change of Modelflow parameters), weight, frequency of dizziness, 24-h urinary sodium and volume, 24-h ambulatory blood pressure (24-ABPM) and presence of ankle oedema were collected at baseline and at 6 weeks. RESULTS: symptoms improved, to a similar extent, in both groups. There were no differences in MAP or other haemodynamic parameters, weight, urinary volume or 24-ABPM between SHU and controls. SHU were more likely to have leg oedema. CONCLUSIONS: these findings suggested that SHU at 6 inches has no additional effects on symptoms or haemodynamic parameters at 6 weeks than existing non-pharmacological measures in older patients with OH. Its use in this group should therefore be discouraged.
RCT Entities:
BACKGROUND: the evidence for 6-inch tilt sleeping-head-up (SHU), a common therapy for the treatment of orthostatic hypotension (OH) in older people, is unavailable. OBJECTIVE: to investigate the effects of 6-inch SHU for 6 weeks in community-living patients with chronic OH. DESIGN: open labelled randomised controlled trial. METHODS: one hundred patients aged ≥60 with chronic OH were randomised into SHU or control groups. Primary outcome measures were mean arterial pressure (MAP) and symptoms. Repeated measures of orthostatic haemodynamic parameters (systolic blood pressure, diastolic blood pressure, MAP, heart rate, percentage change of Modelflow parameters), weight, frequency of dizziness, 24-h urinary sodium and volume, 24-h ambulatory blood pressure (24-ABPM) and presence of ankle oedema were collected at baseline and at 6 weeks. RESULTS: symptoms improved, to a similar extent, in both groups. There were no differences in MAP or other haemodynamic parameters, weight, urinary volume or 24-ABPM between SHU and controls. SHU were more likely to have leg oedema. CONCLUSIONS: these findings suggested that SHU at 6 inches has no additional effects on symptoms or haemodynamic parameters at 6 weeks than existing non-pharmacological measures in older patients with OH. Its use in this group should therefore be discouraged.
Authors: Artur Fedorowski; Fabrizio Ricci; Viktor Hamrefors; Kristin E Sandau; Tae Hwan Chung; James A S Muldowney; Rakesh Gopinathannair; Brian Olshansky Journal: Circ Arrhythm Electrophysiol Date: 2022-02-25