Delayed orthostatic hypotension: Severity of clinical symptoms and response to medical treatment, 2018, Kon Chu et al

https://www.autonomicneuroscience.com/article/S1566-0702(18)30050-X/abstract

Delayed orthostatic hypotension: Severity of clinical symptoms and response to medical treatment


DOI: https://doi.org/10.1016/j.autneu.2018.06.005
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Highlights

• •Patients with delayed OH had less severe orthostatic BP drop than the classic OH.
• •Patients with delayed OH exhibited orthostatic intolerance similar to that of classic OH.
• •Medical treatment improved standing BP drop and associated symptoms in patients with delayed OH.

Abstract
Introduction
Severity of orthostatic intolerance and the benefit of medical treatment in patients with delayed OH have not been elucidated. This study aimed to compare the symptom severity between classic and delayed OH and evaluate the efficacy of midodrine or pyridostigmine in patients with delayed OH.

Methods
This was an adjunctive study of previously reported randomized, open-label clinical trials evaluating the efficacy and safety of midodrine or pyridostigmine for classic OH. Seventeen patients with delayed OH were enrolled and also received midodrine (2.5 mg twice a day) or pyridostigmine (30 mg twice a day) alone or combined. Result of initial orthostatic vital sign and questionnaires were compared between the patients with delayed OH and previously reported 87 patients with classic OH. Delayed OH patients were followed up at 1 and 3 months post-treatment and the vital sign measurements and questionnaires were repeated during the follow-up period.

Results
Questionnaire scores regarding OH-related symptoms, depression and health-related quality of life (HRQOL) were comparable between the classic and delayed OH patients at baseline. OH-related symptoms and depression were significantly improved after 3 months of medical treatment.

Conclusion
Patients with delayed OH exhibited orthostatic intolerance similar to that of classic OH. This study shows that these patients may benefit from medical treatment with either midodrine or pyridostigmine.


Keywords:
Delayed orthostatic hypotension, Midodrine, Pyridostigmine, Efficacy, Treatment