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* Rapid drinking of approximatively 500 mL of cold water, independent of daily water intake  
* Rapid drinking of approximatively 500 mL of cold water, independent of daily water intake  
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Tables
 
 
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | A01 | | | | | |A01=Drop of systolic BP > 20 mmHg (30 for hypertensive patients)}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
{{familytree | | | | | | | | | C01 | | | | | | | | | | | |C02|C01=Symptomatic|C02=Asymptomatic}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | | D01 | | | | | | | | | | | |D02|D01=Non-pharmacological treatment|D02=Observation
and follow-up}}
{{familytree | | | | | | | | | |!| | | | | | | | | }}
{{familytree | | | | | | | | | E01 | | | | | | | |E01=Persistance of symtoms}}
{{familytree | | | | | | | | | |!| | | | | | | | | }}
{{familytree | | | | | | | | | E01 | | | | | | | |E01=Pharmacological Treatment}}
{{familytree | | | | | | | | | |!| | | | | | | | | }}
{{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | }}
{{familytree | | |!| | | | | | | | | | | | | |!| | }}
{{familytree | | E01 | | | | | | | | | | | | E02 | | |E01=No supine hypertension or chronic heart failure|E02=Supine hypertension or chronic heart failure: }}
{{familytree | | |!| | | | | | | | | | | | | |!| | }}
{{familytree | | E01 | | | | | | | | | | | | E02 | | E01= Fludrocortisone<br>Midodrine|E02=Midodrine}}
 
{{familytree/end}}

Revision as of 00:56, 16 August 2020


Non-Pharmacological methods Mechanism of alleviating hypotension Recommendations
Elastic stockings
  • Reduce venous pooling in the splanchnic and mesenteric circulations.
  • Elastic stockings expanding up to the waist are recommended.
  • Leg compression alone is not considered effective.
    • Due to the minor venous capacitance of legs relative to the abdomen.
  • Separate abdominal and leg compression is recommended to avoid patient's discomfort.
Physical Maneuvers
  • Transiently increase venous return and peripheral vascular resistance
  • Contraction of a group of muscles
  • Leg-crossing
  • Toe raising
  • Bending at the waist
Head up tilt sleeping
  • Enhance orthostatic tolerance upon the first-morning rise
  • Results in reduction in supine hypertension, pressure-natriuresis
Intravascular volume
  • Tubular loss of salt and fluid
  • Decreased vascular tone creates relative hypovolemia
  • Volume expansion can alleviate symptoms even in the presence of normal intravascular volume.
    • 2 liters of water and 6 g of salt
    • Twenty-four-hour urine collection is helpful to guide treatment and follow-up
Intake of cold water
  • Increase systolic orthostatic hypotension by more than 30 mmHg
    • Via gastropressor response
  • Rapid drinking of approximatively 500 mL of cold water, independent of daily water intake


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Drop of systolic BP > 20 mmHg (30 for hypertensive patients)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Symptomatic
 
 
 
 
 
 
 
 
 
 
 
Asymptomatic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-pharmacological treatment
 
 
 
 
 
 
 
 
 
 
 
Observation and follow-up
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Persistance of symtoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pharmacological Treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No supine hypertension or chronic heart failure
 
 
 
 
 
 
 
 
 
 
 
Supine hypertension or chronic heart failure:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fludrocortisone
Midodrine
 
 
 
 
 
 
 
 
 
 
 
Midodrine