Compression therapy in patients with orthostatic hypotension: a systematic review

Orthostatic hypotension is common, especially in the elderly, and it is strongly associated with discomfort and falls. Physicians may sometimes prescribe compression therapy, but the beneficial effect of this treatment in orthostatic hypotension is unclear. The aim of this review was to summarise all available evidence on the effect of four different levels of compression therapy in the treatment of orthostatic hypotension: knee-length, thigh-length, full-length and abdominal compression only.

A systematic search was performed in PubMed, Embase and Cochrane databases.

A literature search identified 1232 reports; 11 publications were selected for inclusion in this review. The quality of studies was heterogenous and generally poor. Full length compression (lower limbs and abdomen) and compression of solely the abdomen were found to be superior to knee-length and thigh-length compression. Both significantly reduced the fall in systolic blood pressure after postural change. Symptoms of orthostatic hypotension experienced by patients were improved the most by full-length compression.

When other interventions fail to ameliorate symptoms, compression therapy can be considered. This review demonstrates that compression treatment should include the abdomen as this has the greatest beneficial effect. However, this review also displays the paucity of evidence for compression therapy for patients with orthostatic hypotension, and further investigation is certainly warranted.