Fludrocortisone for orthostatic hypotension

Veazie, Stephanie; Peterson, Kim; Ansari, Yasmin; Chung, Kathryn A.; Gibbons, Christopher H.; Raj, Satish R.; Helfand, Mark

doi:10.1002/14651858.cd012868.pub2

Cited by 20 publications

(14 citation statements)

References 108 publications

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“…Its sodium-retaining effect is transient (Chobanian et al, 1979), and its ongoing effect on blood pressure may be due more to sensitization of vascular α-adrenoreceptors to pressor amines (Davies et al, 1978). A Cochrane review of fludrocortisone found the level of evidence for treating orthostatic hypotension to be weak (Veazie et al, 2021). Potential adverse effects related to volume overload include hypertension, hypertensive retinopathy, peripheral edema, cardiomegaly, and congestive heart failure.…”

Section: Improving Volume Status Without Saltmentioning

confidence: 99%

Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome

Snapper

Cheshire

2022

Autonomic Neuroscience

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Section: Improving Volume Status Without Saltmentioning

confidence: 99%

Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome

Snapper

Cheshire

2022

Autonomic Neuroscience

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“…Though data from RCTs is considered more robust, the RCTs included in this meta-analysis have included small numbers of patients belonging to particular phenotypes, hence it can be argued that real world data could fare better in this condition. As such non-inclusion of non RCTs in this study may be perceived as a limitation and this certainly is the case for medications such as fludrocortisone, as shown in this recent systematic review (39). It is prudent to re-visit and possibly study long term effects of the older approved medications prospectively in phase 4 trials such as NCT04128137 and trials such as CONFORM-OH (40) and/or in registries.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of pharmacological management of orthostatic hypotension- a systematic review and meta-analysis

Kulkarni

Jenkins

Pavey

et al. 2022

Preprint

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Introduction Orthostatic hypotension (OH) is associated with cardiovascular mortality and morbidity. Non-pharmacological and pharmacological therapies are employed in the management of OH. The aim of this systematic review and meta-analysis is to provide an up-to-date review of the efficacy parameters of pharmacological therapies. Methods Medline, Embase, Cochrane Library, and Scopus were searched (inception-July 2021), and published articles with randomized control trials, meeting inclusion and exclusion criteria were quality assessed (Risk of Bias 2 tool). Assessment for trends in patient-related outcome measures and postural blood pressure improvement was undertaken. Studies reporting postural systolic blood pressure (SBP) before and after intervention in comparison to placebo were included in a meta-analysis using inverse -variance in a random-effects model. Results 19 articles were included in the systematic review. The orthostatic symptoms questionnaire (OHQ) was the most common patient-related outcome measure utilized in trials. Six studies included in the meta-analysis demonstrated that pharmacological therapies (pyridostigmine, midodrine, atomoxetine, yohimbine) improved postural SBP compared to placebo, with a mean rise of 12.50 mmHg [95% CI: 6.01, 18.98; p value<0.001, I2 =97%]. Midodrine showed the highest impact on SBP, with a mean SBP of 16.11 mmHg [95% CI: 5.59, 26.63; p=0.003, I2 =99%]. Conclusions Pharmacological treatment can significantly increase postural SBP, however with significant heterogeneity related to trial designs. Further efforts to homogenize outcome measures, incorporating symptom improvement and reduction in the postural drop and testing for a prolonged duration of therapy would strengthen the evidence, and improve the translatability of findings in clinical settings.

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“…Results revealed no significant differences in hemodynamics in overall OH symptoms. However, there was a lack of information regarding long-term efficacy [14]. Thus, long-term and large-scale meta-analyses are required before clinicians can deduce proper conclusions.…”

Section: Treatmentmentioning

confidence: 99%

Refractory Hypotension: A Detailed Case Discussion and Current Literature Review

Memon¹,

Chadda²,

Dahhan³

et al. 2022

Cureus

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Fludrocortisone for orthostatic hypotension

Cited by 20 publications

References 108 publications

Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome

Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome

Efficacy of pharmacological management of orthostatic hypotension- a systematic review and meta-analysis

Refractory Hypotension: A Detailed Case Discussion and Current Literature Review

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