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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
  • 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

Tables