Objective: To investigate the efficacy of an elastic abdominal binder on signs and symptoms of orthostatic hypotension (OH) in a laboratory setting and daily living of people with Parkinson’s disease (PD) and Parkinson-variant multiple system atrophy (MSA-P).

Background: Orthostatic hypotension is a frequent, debilitating non-motor feature of PD and MSA-P, whose pharmacological treatment often remains limited by concomitant supine hypertension.

Method: In this monocentric, randomized, placebo-controlled, double-blind, crossover phase II trial with an open-label treatment extension phase, people with PD or MSA-P and laboratory-confirmed OH were enrolled. Efficacy of wearing an abdominal vs. placebo binder on orthostatic blood pressure (BP) changes was assessed at two clinic visits, separated by a 1-day interval; as well as for two 5-day home phases (one before clinic visits without vs. one afterwards with the abdominal binder). Primary endpoint was change in Δ mean BP at 3^rd min of head-up tilt test after wearing the abdominal vs. placebo binder for 2 hours. Secondary endpoints included differences in absolute and other Δ BP values, symptom burden assessed by the Orthostatic Hypotension Questionnaire (OHQ), and gait parameters measured by wearable sensors. Paired-t-test results are reported as mean difference (SD; 95% CI).

Results: Seventeen participants (n=6 MSA-P, n=11 PD; 71% male) with a median age of 68 and disease duration of 5 years were included. Upon head-up tilt test, similar BP profiles were observed between the abdominal and placebo binder (mean difference in primary endpoint +2.0 [12.1; -4.2, 8.2] mmHg, p=0.248). In home measurements, wearing the abdominal binder reduced the 3 min active standing Δ mean and systolic orthostatic BP fall at noon (+4.0 [5.9; 0.7, 7.3] mmHg, p=0.010; +5.9 [10.1; 0.3, 11.5] mmHg, p=0.020), without increasing supine BP levels, while also reducing the overall symptom burden (OHQ total score -8.7 [12.0; -15.4, -2.1]; p=0.007). First analyses of laboratory- and home-based gait parameters showed comparable results between the interventional and placebo binder.

Conclusion: While no acute changes in orthostatic hemodynamic responses were observed, these findings suggest that wearing an abdominal binder may serve as an effective and practical non-pharmacological measure to alleviate OH and reduce its burden in daily life of people with PD and MSA-P, especially in case of concomitant supine hypertension.

References: If possible, please add additional co-authors Giulia Saccardin, Kathrin Marini, and Marina Peball (all three are affiliated with affiliation number 1: Department of Neurology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria) between K. Gotwald and C. Raccagni.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/abdominal-binders-to-treat-orthostatic-hypotension-in-parkinsonian-syndromes/