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Midodrine, an alpha-agonist that increases total peripheral resistance, has been proposed as a treatment for neurogenic orthostatic hypotension. Investigators in this double-blind, controlled trial randomized 171 hypotensive patients, most of whom had diabetic autonomic neuropathy, Shy-Drager syndrome, or pure autonomic failure, to treatment with either 10 mg of midodrine or placebo three times a day for three weeks.
At follow-up one week into treatment, the midodrine group had an average increase in standing systolic blood pressure of about 22 mm Hg versus an increase of less than 5 mm Hg in the placebo group. These blood pressures remained consistent throughout the treatment period in both groups. Supine blood pressures also rose with mido…