Treatment of orthostatic hypotension: interaction of pressor drugs and tilt table conditioning.

We describe a patient with severe orthostatic hypotension in whom tilt table conditioning had a striking, beneficial effect. Upon presentation, the patient was unable even to sit, and the deconditioning associated with prolonged bed rest worsened his autonomic dysfunction. Although he was sensitive to the pressor effects of vasoconstrictor drugs (dihydroergotamine, caffeine, and a somatostatin analogue), these agents failed to stabilize his walking blood pressure. With drug therapy, however, the patient could maintain an adequate blood pressure while performing isometric exercises on a tilt table, whose angle was gradually increased during three weeks. After this conditioning program, pressor drug therapy made it possible for the patient to walk. Although the physiologic basis for this therapeutic response is unclear, our results indicate that tilt table conditioning may be an important adjunct to drug therapy in patients with severe orthostatic hypotension.