Increased Salt Intake for Orthostatic Intolerance Syndromes: A Systematic Review and Meta-Analysis

Guidelines recommend increased salt intake as a first-line recommendation in the management of symptomatic orthostatic hypotension and recurrent syncope. There have been no systematic reviews of this intervention. We sought to summarize the evidence for increased salt intake in patients with orthost...

Full description

Saved in:

Bibliographic Details
Published in:	The American journal of medicine Vol. 133; no. 12; pp. 1471 - 1478.e4
Main Authors:	Loughlin, Elaine A., Judge, Conor S., Gorey, Sarah E., Costello, Maria M., Murphy, Robert P., Waters, Ruairi F., Hughes, Diarmaid S., Kenny, Rose Ann, O'Donnell, Martin J., Canavan, Michelle D.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-12-2020
Subjects:	Adult Falls Humans Middle Aged Orthostatic hypotension Orthostatic intolerance Orthostatic Intolerance - diet therapy Salt Sodium Chloride, Dietary - administration & dosage Syncope Young Adult Falls Salt Syncope Orthostatic intolerance Orthostatic hypotension
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Guidelines recommend increased salt intake as a first-line recommendation in the management of symptomatic orthostatic hypotension and recurrent syncope. There have been no systematic reviews of this intervention. We sought to summarize the evidence for increased salt intake in patients with orthostatic intolerance syndromes. We conducted a systematic review and meta-analysis of studies in PubMed, EMBASE, and CINAHL. Interventional studies that increased salt intake in individuals with orthostatic intolerance syndromes were included. Primary outcome measures included incidence of falls and injuries, and rates of syncope and presyncope. Secondary outcome measures included other orthostatic intolerance symptoms, blood pressure, and heart rate. A total of 14 studies were eligible, including participants with orthostatic hypotension, syncope, postural orthostatic tachycardia syndrome, and idiopathic orthostatic tachycardia (n = 391). Mean age was 35.6 (± 15) years. All studies were small and short-term (<60 mins-90 days). No study reported on the effect of increased salt intake on falls or injuries. Meta-analysis demonstrated that during head-up tilt, mean time to presyncope with salt intake increased by 1.57 minutes (95% confidence interval [CI], 1.26-1.88), mean systolic blood pressure increased by 12.27 mm Hg (95% CI, 10.86-13.68), and mean heart rate decreased by −3.97 beats per minute (95% CI, −4.08 to −3.86), compared with control. Increased salt increased supine blood pressure by 1.03 mm Hg (95% CI, 0.81 to 1.25). Increased salt intake resulted in an improvement or resolution of symptoms in 62.3% (95% CI, 51.6 to 72.6) of participants in short-term follow-up studies (mean follow-up of 44.3 days, 6 studies; n=91). Methodological quality of studies were low with high statistical heterogeneity in all meta-analyses. Our meta-analysis provides low-quality evidence of a short-term improvement in orthostatic intolerance with increased salt intake. There were no clinical trials demonstrating the efficacy and safety of increased salt intake on long-term clinical outcomes. Overall, there is a paucity of clinical trial evidence to support a cornerstone recommendation in the management of orthostatic intolerance syndromes.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	0002-9343 1555-7162
DOI:	10.1016/j.amjmed.2020.05.028