Twenty-six studies were included in the review (n=496): eight evaluated pharmacologic interventions and twenty-one evaluated non-pharmacologic interventions. Sample size ranged from one to 231. The studies were generally of poor quality. The quality score of RCTs ranged from 2 to 5; the quality core of other studies ranged from 7 to 22.
One RCT reported that midodrine improved exercise performance in some patients with spinal cord injury. One case series showed no effect of fludrocortisone on orthostatic hypotension in patients with spinal cord injury. One case report showed that daily ergotamine in combination with fludrocortisone prevented symptomatic orthostatic hypotension in a patient with spinal cord injury.
One observational study reported that ephedrine reduced the likelihood of patients who experienced hypotension. One case report showed that L-DOPS in combination with salt supplementation led to a marked reduction of syncopal attacks, a decrease of hypotension symptoms and an increase of daily activity.
Two observational studies reported that salt and fluid regulation in combination with other pharmacologic interventions reduced symptoms of orthostatic hypotension. One RCT showed that pressure from elastic stockings and abdominal binders increased cardiovascular physiologic responses during sub-maximal, but not maximal, upper-extremity exercises; other studies showed contradictory findings.
Three RCTs reported that functional electrical stimulation as a treatment adjunct minimised cardiovascular changes during postural orthostatic stress in patients with spinal cord injury. One RCT showed that simultaneous upper-extremity exercise increased orthostatic tolerance during a progressive tilt exercise in patient with paraplegia; one RCT showed no effect of this intervention in patients with tetraplegia. One pre-post study reported that body weight support treadmill training did not improve orthostatic tolerance during a tilt test.