Blood Pressure, 2014; 23: 248–254

ORIGINAL ARTICLE

Factors associated with prevention of postural hypotension by leg compression bandaging

OLEG GORELIK1, MIRIAM SHTEINSHNAIDER1, IRMA TZUR1, LEONID FELDMAN2, NATAN COHEN1 & DORIT ALMOZNINO-SARAFIAN1 Departments of 1Internal Medicine “F” and 2Nephrology, Assaf Harofeh Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University), Zerifin, Israel Abstract Aim. We evaluated the eventual effects of leg compression on seating-induced postural hypotension (PH) in the context of various relevant clinical variables. Methods. Included were 73 hospitalized patients with various acute conditions, aged  60 years, bedridden for  8 h, with diagnosed PH [ 20 mmHg systolic and/or  10 mmHg diastolic blood pressure (BP) falls] at the first seating. BP, heart rhythm, dizziness and palpitations were recorded before and during 5 min of sitting. The next day, the patients were reevaluated, this time using compression bandages applied along both legs before seating. Results. Compared with the non-bandaged state, PH was registered in only 53% of bandaged patients (p  0.001). Moreover, the appearance of PH symptoms decreased (p  0.001). On the second day (bandaged), supine diastolic BP values were higher in the persisting vs non-persisting PH group (p  0.027). In the bandaged state, PH symptoms were significantly reduced in the non-persisting PH group (p  0.003). Even in patients with persistent PH, the magnitude of BP decline and appearance of PH symptoms were decreased while wearing bandages (p  0.004 and 0.002, respectively). Conclusion. During mobilization of inpatients, leg compression seems to reduce the seating-induced PH and relevant symptoms. Even in patients with persisting PH, bandaging may improve hemodynamics and attenuate associated symptoms. Key Words: Compression bandages, hypertension, postural hypotension, seating

Introduction Transition of hospitalized older patients from lying to upright position may be difficult and potentially dangerous, because such patients are often limited in muscle strength or mobility and at risk for symptomatic postural hypotension (PH) (1–4). Thus, sitting before standing is recommended (4–6). However, in 98 older patients admitted to an internal medicine ward for various acute conditions and confined to bed for  12 h, seating-induced PH and its symptoms appeared in 54% and 80.6%, respectively (7). Moreover, among 108 patients hospitalized for acutely decompensated heart failure, the respective rates of PH and related symptoms were 49% and 25% on transition from supine to sitting position (8). The inpatient population carries multiple predisposing factors for PH, such as advanced age, bed

rest, hypovolemia, use of diuretics, vasodilators and other relevant drugs (3–8). Moreover, hypertension, heart failure, diabetes mellitus, anemia and renal dysfunction are common in hospitalized patients and may contribute to the development of PH (3–8). Since seating-induced PH and related symptoms are common in older patients admitted to the internal medicine ward, measures for their prevention should be undertaken. Surprisingly, information on the prevention of PH in inpatients is scarce. In one of the few studies on the subject, leg compression bandaging was not found to reduce PH incidence, though it was associated with decreased symptoms of PH (9). In another investigation, lower limb compression bandages eliminated PH in only 21 of 49 (43%) patients, without ameliorating PH-related symptoms (8). Thus, the benefit of compression bandaging on PH appearance in hospitalized patients

Correspondence: Oleg Gorelik, Department of Internal Medicine “F”, Assaf Harofeh Medical Center, Zerifin 70300, Israel. Tel: 972-8-9779994/1. Fax: 972-8-9779976. E-mail: [email protected] (Received 15 July 2013 ; accepted 6 November 2013) ISSN 0803-7051 print/ISSN 1651-1999 online © 2014 Scandinavian Foundation for Cardiovascular Research DOI: 10.3109/08037051.2013.871787

Leg bandaging and postural hypotension remains inconclusive. Moreover, the influence of various clinical factors on the eventual effects of leg compression bandaging for PH is not clear. The present study was undertaken with a dual aim: firstly, to evaluate the effects of leg bandaging on PH and the associated clinical phenomena following transition from lying to sitting position. Secondly, we aimed to determine the relevant clinical variables that predict response to compression bandaging.

Methods Study population We studied 73 patients hospitalized in our medical department for various acute conditions. Inclusion criteria were as follows: age  60 years; bed rest duration  8 h; presence of PH on the first seating. Impaired consciousness, non-cooperation, inability to sit, and hemodynamic or respiratory instability served as main exclusion criteria. Excluded were also patients with ulcers, arterial insufficiency and/or significant edema of legs (in order to avoid local complications of compression bandages). According to the instructions of the bandage manufacturer, all patients with lower limb circumference of  18 or  35 cm were also excluded from the study.

Study design Evaluation of patients comprised medical history intake, physical examination, routine laboratory tests, chest X-ray and electrocardiogram. The duration of the study was 2 days for each patient. Evaluation of PH was performed in the morning, while fasting, prior to oral drug administration and at least 12 h after withdrawal of intravenous medications. At day 1, seating-induced PH was diagnosed as follows. Cuff blood pressure (BP) and heart rhythm were recorded in the supine position, using DINAMAPTM XL vital signs monitor (Johnson & Johnson Medical Incorporation, Arlington, TX, USA). To avoid the effect of the first BP measurement stress, the latter was assessed three sequential times at 3-min intervals. If differences in systolic and/or diastolic BP values did not exceed 8 and 3 mmHg, respectively, the measurements were considered acceptable and the third values were taken as supine baseline. In cases of higher variability, BP determinations were repeated until three sequential estimations satisfied the abovementioned criteria. Immediately thereafter, two staff members assisted each patient to be seated, with his/ her legs bent at the knee and hanging over the side of the bed. Throughout the maneuver, the patient was instructed to remain passive. BP, heart rhythm and the resulting manifestations of PH were registered 1, 3 and 5 min following the seating. The patients were then returned to bed in supine position.

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On the second day the same tests were performed, this time using compression bandages on all patients. Thus, any given patient served as his/her own control. Before seating, compression extensible bandages (Setopress, Seton Healthcare Group plc, Oldham, UK) were stretched along both legs from the ankle to the end of the thigh, so that the designed rectangles became transformed into squares, to obtain an uniform pressure of about 30–40 mmHg at the ankle (8–10). Depending on the persistence of PH on the second day of the study, the patients were divided into two groups for analysis: those not manifesting PH (non-persisting PH group) and those retaining PH despite the bandage applying (persisting PH group). The study was carried out in accordance with the Declaration of Helsinki and was approved by the local ethics committee. Informed consent was obtained from each patient. Definitions PH was defined as a drop of  20 mmHg in systolic and/or  10 mmHg in diastolic BP in any of the measurements in the sitting position, as compared with the supine reading. Relevant manifestations of PH included appearance of dizziness, palpitations and cardiac arrhythmia, following seating (3,7–9,11). Impaired consciousness, lightheadedness or temporary visual disturbances were included in the definition of dizziness. PH symptoms were registered based on complaints reported by the patients. Cardiac arrhythmias were recorded by the vital signs monitor and included atrial or ventricular premature beats  6/min, couplets, atrial fibrillation, supraventricular or ventricular tachycardia. Anemia, according to the WHO criteria, was defined as hemoglobin concentration of  13 g/dl in men and  12 g/dl in women. Definition of renal dysfunction was estimated glomerular filtration rate  60 ml/min/1.73 m2. Statistical analysis The analyzed variables included systolic and/or diastolic BP, heart rate, appearance of PH, dizziness, palpitations and/or cardiac arrhythmia, duration of bed rest and other relevant clinical parameters. Statistical comparison of data was performed between the groups of patients with persisting vs non-persisting PH. In addition, data were compared between the not bandaged (first study day) and bandaged (second study day) states in the entire group, as well as in the two study groups separately. ANOVA was adopted for quantitative variables. Pearson’s χ2 test or Fisher’s exact test were applied for non-parametric data, where appropriate. ANOVA with repeated measurements was used to determine changes over time of continuous variables. A p-value  0.05 was

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considered significant. The statistical analysis was performed using Biomedical Package (BMDP) software program (12).

Results Data of the entire patient group Table I depicts baseline characteristics of the 73 patients. The most common reasons for admission were acute coronary syndrome and decompensated heart failure. Mean bed rest duration was 35.3  56 h (median value – 10 h). Hypertension, heart failure, coronary artery disease, diabetes mellitus, anemia and renal failure prevailed among the relevant comorbidities. Diuretics, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and betareceptor blockers were the most frequently used medications. On the first study day, PH was symptomatic in 32 (43.8%) of 73 patients manifesting PH. Table II compares clinical data in the unbandaged (first study day) and bandaged (second study day) states. PH disappeared following bandaging in 34 of 73 patients (46.6%, p  0.001). Moreover, the occurrence of relevant symptoms was less frequent in the bandaged vs unbandaged states (34.2% vs 43.8%, p  0.001). Mean supine values of systolic

and diastolic BP were comparable on both study days. However, in the sitting position the respective values of systolic and diastolic BP were lower in the unbandaged than in the bandaged state (Table II). All patients completed the study. No serious adverse events (syncope, fall or life-threatening arrhythmia) were registered. No local leg complications were observed following bandaging. Comparison of data between the persisting and non-persisting PH groups Demographic characteristics, main reasons for admission, duration of bed rest, prevalence of comorbidities and treatment with relevant medications were comparable between patients with and without persisting PH in the bandaged state (Table I). On day 1 (no bandages), the appearance of PH symptoms, as well as mean values of heart rate, systolic and diastolic BP in all measurements, were comparable between the persisting and non-persisting PH groups (data are not presented). On day 2 (bandaged), the rates of PH symptoms did not differ significantly between these groups (Table III). Mean values of BP were comparable between those with and without persisting PH, except for the significantly higher mean supine diastolic BP level in the group with persisting PH (Table III).

Table I. Baseline characteristics of the patients enrolled in the study. Variable Age, years Male sex Main reasons for admission Acute coronary syndrome Exacerbation of heart failure Infection Other Bed rest duration, h Comorbid diseases Hypertension Heart failure Coronary artery disease Diabetes mellitus Anemia Renal dysfunction History of stroke Polyneuropathy Medications used Diuretics ACE-inhibitors/ARBs Beta-receptor blockers Calcium antagonists Anti-arrhythmic drugs Alpha-receptor blockers Nitrates Psychotropic

Entire group (n  73)

Persisting PH group (n  39)

Non-persisting PH group (n  34)

p-value*

75.2  9 30.1%

74.8  9 35.9%

75.6  9 23.5%

0.7 0.3

34.2% 34.2% 20.5% 11% 35.3  56

30.8% 35.9% 17.9% 15.4% 33.2  59

38.2% 32.4% 23.5% 5.9% 37.8  53

0.6 0.8 0.6 0.3 0.7

90.4% 75.3% 56.2% 53.4% 49.3% 42.5% 26% 9.6%

92.3% 79.5% 53.8% 53.8% 51.3% 48.7% 30.8% 5.1%

88.2% 70.6% 58.8% 52.9% 47.1% 35.3% 20.6% 14.7%

0.7 0.4 0.8 0.9 0.8 0.3 0.4 0.2

80.8% 63% 60.3% 39.7% 23.3% 20.5% 17.8% 8.2%

82.1% 66.7% 64.1% 38.5% 20.5% 23.1% 15.4% 10.3%

79.4% 58.8% 55.9% 41.2% 26.5% 17.6% 20.6% 5.9%

0.9 0.6 0.6 0.9 0.6 0.8 0.8 0.7

Data are expressed as mean SD or percentages of presented cases. *Statistical comparison between groups of patients with persisting vs non-persisting PH. PH, postural hypotension; ACE, angiotensinconverting enzyme; ARBs, angiotensin receptor blockers.

Leg bandaging and postural hypotension

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Table II. Comparison of clinical variables of entire patients group (n  73) in unbandaged vs bandaged states. Variable

Unbandaged state (1st study day)

Bandaged state (2nd study day)

100% 43.8% 37% 21.9% 6.8%

53.4% 34.2% 24.7% 12.3% 5.5%

 0.001  0.001  0.001 0.02 0.8

77.6  18 81.6  20 80.5  19 81.5  19

77.8  17 78.3  17 78.8  16 78.4  17

1.0 0.1 0.5 0.1

153.6  28 142.6  29 142.9  28 137.6  28

153.5  29 147.8  29 149.2  28 148.4  27

1.0 0.048 0.01  0.001

77.4  17 71.5  19 70.6  17 69.2  18

78.2  17 74.1  16 74.2  15 74.9  16

0.6 0.1 0.02  0.001

Appearance of PH Appearance of PH symptoms Dizziness Palpitations Appearance of arrhythmia Heart rate (beats/min) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Systolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Diastolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting

p-value

Data are expressed as mean SD or percentages of presented cases. PH, postural hypotension. The significance of bold entries in the table was a p-value of 0.05.

Comparison of data in the non-persisting PH group in the unbandaged vs bandaged states

Comparison of data in the persisting PH group in the unbandaged vs bandaged states

In patients for whom PH disappeared following compression bandaging, the occurrence of PH symptoms was significantly diminished (Table IV). Mean supine values of heart rate as well as of systolic and diastolic blood pressure were comparable in both study days. However, in a bandaged state, seating-induced heart rate acceleration and blood pressure fall were largely prevented (Table IV).

In patients for whom PH persisted following compression bandaging, the appearance of PH symptoms was significantly decreased in the bandaged vs the unbandaged state (Table V). Mean values of heart rate and BP were comparable on both study days, except for a significantly increased mean value of systolic BP following 5 min sitting on the second study day (Table V).

Table III. Comparison of clinical characteristics between groups of patients with persisting vs non-persisting PH in bandaged state (second study day). Variable Appearance of PH Appearance of PH symptoms Dizziness Palpitations Appearance of arrhythmia Heart rate (beats/min) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Systolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Diastolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting

Persisting PH group (n  39) 100% 33.3% 20.5% 12.8% 5.1%

Non-persisting PH group (n  34) 0% 35.3% 29.4% 11.8% 5.9%

p-value  0.001 0.9 0.4 0.9 0.9

80.6  19 81.5  18 81.9  17 80.7  17

74.6  15 74.7  14 75.1  15 75.9  17

0.13 0.07 0.07 0.2

157.3  26 145.2  30 147.0  28 147.5  27

149.2  32 150.9  28 151.7  27 149.5  27

0.2 0.4 0.5 0.7

82.1  18 73.1  17 73.5  17 75.4  18

73.6  14 75.2  14 75.0  13 74.3  13

0.027 0.6 0.7 0.8

Data are expressed as mean  SD or percentages of presented cases. PH, postural hypotension. The significance of bold entries in the table was a p-value of 0.05.

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O. Gorelik et al. Table IV. Comparison of clinical variables of patients with non-persisting PH (n  34) in unbandaged vs bandaged states. Variable Appearance of PH Appearance of PH symptoms Dizziness Palpitations Appearance of arrhythmia Heart rate (beats/min) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Systolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Diastolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting

Unbandaged state (1st study day)

Bandaged state (2nd study day)

100% 47.1% 44.1% 26.5% 5.9%

0% 35.3% 29.4% 11.8% 5.9%

 0.001 0.003 0.001 0.048 1.0

75.1  17 81.2  20 78.9  19 78.4  19

74.6  15 74.7  14 75.1  15 75.9  17

0.8 0.02 0.1 0.4

150.3  28 140.2  28 141.2  27 139.1  31

149.2  32 150.9  28 151.7  27 149.5  27

0.7 0.005  0.001 0.001

73.9  16 68.9  19 67.3  16 66.5  15

73.6  14 75.2  14 75.0  13 74.3  13

0.9 0.02  0.001  0.001

p-value

Data are expressed as mean  SD or percentages of presented cases. PH, postural hypotension.

Discussion The results of this study demonstrate the benefits of lower limb compression bandaging on the disappearance of seating-induced PH and the associated symptoms in patients admitted to an internal medicine ward. Mobilization of patients by seating following bed rest is advisable, because their assuming a standing position may be difficult and dangerous (4–6). However, in older patients hospitalized for acute conditions, PH is common even

on transition from supine to sitting position, ranging from 49% to 54%, and is frequently symptomatic (7,8). Thus, additional measures for prevention of PH should be undertaken during ambulation of inpatients following bed rest. Solid data regarding the prevention of PH in this common clinical situation is scarce. A wide range of non-pharmacological and pharmacological therapies are recommended to treat chronic neurogenic PH (5,6). In older inpatients, PH is generally acute and

Table V. Comparison of clinical variables of patients with persisting PH (n  39) in unbandaged vs bandaged states. Variable Appearance of PH Appearance of PH symptoms Dizziness Palpitations Appearance of arrhythmia Heart rate (beats/min) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Systolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting Diastolic blood pressure (mmHg) Supine Following 1 min sitting Following 3 min sitting Following 5 min sitting

Unbandaged state (1st study day)

Bandaged state (2nd study day)

p-value

100% 41% 30.8% 17.9% 7.7%

100% 33.3% 20.5% 12.8% 5.1%

1.0 0.002 0.006 0.2 0.8

79.8  19 82.1  19 82.0  18 84.2  20

80.6  19 81.5  18 81.9  17 80.7  17

156.4  28.6 144.7  30.6 144.4  29.3 136.2  26.5

157.3  26 145.2  30 147.0  28 147.5  27

0.8 0.9 0.5 0.004

80.5  17 73.7  20 73.5  17 71.5  20

82.1  18 73.1  17 73.5  17 75.4  18

0.4 0.7 1.0 0.08

0.8 0.9 1.0 0.4

Data are expressed as mean  SD or percentages of presented cases. PH, postural hypotension. The significance of bold entries in the table was a p-value of 0.05.

Leg bandaging and postural hypotension potentially transient, resulting from reversible predisposing factors, such as bed rest, hypovolemia, use of diuretics, vasodilators and other relevant drugs (3–8). Moreover, PH may be aggravated by a variety of chronic disorders (3–8). In this patient population, pharmacological intervention for PH is problematic and often contraindicated due to a high prevalence of cardiovascular diseases. Moreover, in the defined clinical setting, non-pharmacological treatment of PH has not been thoroughly investigated. Among the non-pharmacological measures for treatment of chronic PH, a variety of lower body compression devices are recommended (11,13,14). Leg compression bandaging is a simple and nonexpensive technique that may be easily applied in hospitalized patients. This device was previously evaluated for prevention of seating-induced PH and associated symptoms in two studies (8,9). One of them, designed as a randomized crossover study, demonstrated that leg compression bandaging did not reduce PH incidence, although it was associated with decrease in PH symptoms in older inpatients with various acute conditions who had been bedridden for at least 36 h (9). In contrast, in a case–control study, lower limb compression bandages prevented seated PH in 43% of 49 patients admitted for acutely decompensated heart failure, though they did not significantly reduce PH symptoms (8). These studies demonstrated clear benefits of leg compression bandaging for the prevention of PH and its associated symptoms in a considerable proportion of hospitalized patients. The reasons for the ineffectiveness of the bandaging for some patients are not known. Clinical factors that may be associated with potential benefits of compression bandaging on PH persistence have not yet to be investigated. The main aim, and the main novelty, of the present study were the investigation of factors that may be associated with persistence of PH despite applying bandages, in a relatively large and heterogeneous population of inpatients. Accordingly, we comprised in the current investigation 73 patients hospitalized for various acute conditions and manifesting seating-induced PH following bed rest of at least 8 h. In 43.8% of them PH was symptomatic. On the second day of the study, when the compression bandages were applied, PH disappeared in 46.6% of the 73 patients. Moreover, in the bandaged state, occurrences of dizziness and palpitations were significantly diminished. Leg compression bandaging seems to be associated with reduced PH and its symptoms, most probably via mechanisms of reducing the blood pooling in the lower limb capacitance vessels, thus leading to maintenance of venous return to the heart and attenuation of cardiac output reduction (9,11,13). Nevertheless, PH and its symptoms persisted in a considerable proportion of patients (53.4% and 34.2%, respectively), despite the bandage application. We have initially presumed that the

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patients’ response to the bandaging would be affected by at least some of the known risk factors for PH. Surprisingly, however, there were no statistically significant differences in demographic characteristics, main reasons for admission, duration of bed rest, prevalence of co-morbidities and treatment with relevant medications between the persisting and non-persisting PH groups. On the other hand, there were other factors that impacted responsiveness to the leg compression in PH patients. Specifically, higher supine diastolic BP was found to be associated with the inability of compression bandaging to prevent PH. Higher prevalence of diastolic vs systolic PH and the association of PH with supine diastolic hypertension were reported previously in hospitalized patients (8,15). The hypo-adrenergic state and reduced arterial sensitivity to the compensatory effect of the sympathetic system have been suggested as important components for the development of diastolic PH in older sick patients (15). Similarly, these factors may have contributed to the persistence of PH, despite the use of bandages. Other possible explanations for ineffectiveness of the bandaging may be insufficient correction of dehydration in some patients with persistent PH. On the other hand, high day-to-day variability of PH, which was reported in hospitalized patients (1,4,9,15), may be responsible for the disappearance of PH in some of the patients. This study shows that for considerable proportion of patients with non-persisting seating-induced PH, PH symptoms, heart rate acceleration and BP decline were largely attenuated by compression bandaging. Moreover, the use of bandages apparently benefited even patients with persistent PH, as evident by a lower rate of symptomatic PH and a lesser magnitude of BP fall following seating. The present study comprises a relatively small number of patients. Still, it represents one of the largest investigations that has been conducted on PH prevention. The lack of a control group not subjected to intervention can be considered a major limitation of this study. However, application of compression bandages has become routine practice in our medical department, due to its demonstrated benefit in preventing PH and its symptoms (8,9). Thus, depriving PH patients of receiving compression bandaging for experimental reasons would be unethical and contradict the Good Clinical Practice (GCP) principles. Hence, we conducted a case–control study, which is a priory not based on inclusion of control group. The fact that each patient served as his/her own control is a strength of this study. Nevertheless, the singlecenter design may reduce its generalizability. In conclusion, lower limb compression bandaging seems beneficial for reducing the seating-induced PH and its symptoms during mobilization of inpatients. Even in patients with persisting PH, bandaging may

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improve hemodynamics and attenuate associated symptoms. Disclosures None. References 1. Puisieux F, Boumbar Y, Bulckaen H, Bonnin E, Houssin F, Dewailly P. Intraindividual variability in orthostatic blood pressure changes among older adults: The influence of meals. J Am Geriatr Soc. 1999;47:1332–1336. 2. Vloet LC, Pel-Little RE, Jansen PA, Jansen RW. High prevalence of postprandial and orthostatic hypotension among geriatric patients admitted to Dutch hospitals. J Gerontol A Biol Sci Med Sci. 2005;60:1271–1277. 3. Gorelik O, Fishlev G, Litvinov V, Almoznino-Sarafian D, Alon I, Shteinshnaider M, et al. First morning standing up may be risky in acutely ill older inpatients. Blood Press. 2005; 14:139–143. 4. Feldstein C, Weder AB. Orthostatic hypotension: A common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens. 2012;6:27–39. 5. Lipsitz LA. Orthostatic hypotension in the elderly. N Engl J Med. 1989;321:952–957. 6. Sclater A, Alagiakrishnan K. Orthostatic hypotension: A primary care primer for assessment and treatment. Geriatrics. 2004;59:22–27.

7. Cohen N, Gorelik O, Fishlev G, Almoznino-Sarafian D, Alon I, Shteinshnaider M, et al. Seated postural hypotension is common among older inpatients. Clin Auton Res. 2003; 13:447–449. 8. Gorelik O, Almoznino-Sarafian D, Litvinov V, Alon I, Shteinshnaider M, Dotan E, et al. Seating-induced postural hypotension is common in older patients with decompensated heart failure and may be prevented by lower limb compression bandaging. Gerontology. 2009;55:138–144. 9. Gorelik O, Fishlev G, Almoznino-Sarafian D, Alon I, Weissgarten J, Shteinshnaider M, et al. Lower limb compression bandaging is effective in preventing signs and symptoms of seating-induced postural hypotension. Cardiology. 2004; 102:177–183. 10. Blair SD, Wright DD, Backhouse CM, Riddle E, McCollum CN. Sustained compression and healing of chronic venous ulcers. Br Med J. 1988;297:1159–1161. 11. Podoleanu C, Maggi R, Brignole M, Croci F, Incze A, Solano A, et al. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons. J Am Coll Cardiol. 2006;48:1425–1432. 12. Dixon WJ (Chief editor): BMDP statistical software. Los-Angeles, CA: University of California Press; 1993. 13. Sheps SG. Use of an elastic garment in the treatment of orthostatic hypotension. Cardiology. 1976;61:271–279. 14. Henry R, Rowe J, O’Mahony D. Haemodynamic analysis of efficacy of compression hosiery in elderly fallers with orthostatic hypotension. Lancet. 1999;354:45–46. 15. Weiss A, Grossman E, Beloosesky Y, Grinblat J. Orthostatic hypotension in acute geriatric ward: Is it a consistent finding? Arch Intern Med. 2002;162:2369–2374.

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Factors associated with prevention of postural hypotension by leg compression bandaging.

We evaluated the eventual effects of leg compression on seating-induced postural hypotension (PH) in the context of various relevant clinical variable...
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