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Treatment of orthostatic hypotension due to autonomic failure with a peripheral alpha-adrenergic agonist (midodrine).
Neurology. 1988 Jun; 38(6):951-6.Neur

Abstract

The therapeutic efficacy of midodrine, an alpha-adrenergic agonist that does not cross the blood-brain barrier, was investigated in a double-blind crossover trial in seven patients with orthostatic hypotension due to autonomic failure. We identified two groups of patients: those in whom upright mean arterial pressure significantly increased (group I, n = 3) and those in whom upright mean arterial pressure decreased (group II, n = 4) during midodrine treatment. Body weight changed in a parallel manner with upright blood pressure, increasing in patients of group I and decreasing in patients of group II (p less than 0.05). Autonomic cardiovascular reflexes were significantly more impaired in patients of group II than in patients of group I. We conclude that midodrine is effective in the treatment of orthostatic hypotension only in those patients with significant preservation of autonomic reflexes. Conversely, in patients with markedly impaired baroreceptor mechanisms, treatment with midodrine may produce extracellular fluid volume depletion and exacerbate orthostatic hypotension.

Authors+Show Affiliations

Department of Neurology, Mount Sinai Hospital, New York, NY 10029.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2452997

Citation

Kaufmann, H, et al. "Treatment of Orthostatic Hypotension Due to Autonomic Failure With a Peripheral Alpha-adrenergic Agonist (midodrine)." Neurology, vol. 38, no. 6, 1988, pp. 951-6.
Kaufmann H, Brannan T, Krakoff L, et al. Treatment of orthostatic hypotension due to autonomic failure with a peripheral alpha-adrenergic agonist (midodrine). Neurology. 1988;38(6):951-6.
Kaufmann, H., Brannan, T., Krakoff, L., Yahr, M. D., & Mandeli, J. (1988). Treatment of orthostatic hypotension due to autonomic failure with a peripheral alpha-adrenergic agonist (midodrine). Neurology, 38(6), 951-6.
Kaufmann H, et al. Treatment of Orthostatic Hypotension Due to Autonomic Failure With a Peripheral Alpha-adrenergic Agonist (midodrine). Neurology. 1988;38(6):951-6. PubMed PMID: 2452997.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of orthostatic hypotension due to autonomic failure with a peripheral alpha-adrenergic agonist (midodrine). AU - Kaufmann,H, AU - Brannan,T, AU - Krakoff,L, AU - Yahr,M D, AU - Mandeli,J, PY - 1988/6/1/pubmed PY - 1988/6/1/medline PY - 1988/6/1/entrez SP - 951 EP - 6 JF - Neurology JO - Neurology VL - 38 IS - 6 N2 - The therapeutic efficacy of midodrine, an alpha-adrenergic agonist that does not cross the blood-brain barrier, was investigated in a double-blind crossover trial in seven patients with orthostatic hypotension due to autonomic failure. We identified two groups of patients: those in whom upright mean arterial pressure significantly increased (group I, n = 3) and those in whom upright mean arterial pressure decreased (group II, n = 4) during midodrine treatment. Body weight changed in a parallel manner with upright blood pressure, increasing in patients of group I and decreasing in patients of group II (p less than 0.05). Autonomic cardiovascular reflexes were significantly more impaired in patients of group II than in patients of group I. We conclude that midodrine is effective in the treatment of orthostatic hypotension only in those patients with significant preservation of autonomic reflexes. Conversely, in patients with markedly impaired baroreceptor mechanisms, treatment with midodrine may produce extracellular fluid volume depletion and exacerbate orthostatic hypotension. SN - 0028-3878 UR - https://www.unboundmedicine.com/medline/citation/2452997/Treatment_of_orthostatic_hypotension_due_to_autonomic_failure_with_a_peripheral_alpha_adrenergic_agonist__midodrine__ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=2452997.ui DB - PRIME DP - Unbound Medicine ER -