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Effects of Midodrine Hydrochloride on Blood Pressure and Cerebral Blood Flow During Orthostasis in Persons With Chronic Tetraplegia

  • Jill M. Wecht
    Correspondence
    Reprint requests to Jill M. Wecht, EdD, Center of Excellence: Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Room 1E-02, 130 West Kingsbridge Rd, Bronx, NY 10468
    Affiliations
    James J. Peters Veterans Administration Medical Center, Bronx, NY, Center of Excellence

    Medical Service, the Mount Sinai School of Medicine, New York, NY

    Department of Medicine, Old Westbury, NY

    Department of Rehabilitation Medicine, Old Westbury, NY
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  • Dwindally Rosado-Rivera
    Affiliations
    James J. Peters Veterans Administration Medical Center, Bronx, NY, Center of Excellence
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  • John P. Handrakis
    Affiliations
    James J. Peters Veterans Administration Medical Center, Bronx, NY, Center of Excellence

    NYIT—School of Health Professions, Old Westbury, NY
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  • Miroslav Radulovic
    Affiliations
    James J. Peters Veterans Administration Medical Center, Bronx, NY, Center of Excellence

    Medical Service, the Mount Sinai School of Medicine, New York, NY

    Department of Medicine, Old Westbury, NY

    Department of Rehabilitation Medicine, Old Westbury, NY
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  • William A. Bauman
    Affiliations
    James J. Peters Veterans Administration Medical Center, Bronx, NY, Center of Excellence

    Medical Service, the Mount Sinai School of Medicine, New York, NY

    Department of Medicine, Old Westbury, NY

    Department of Rehabilitation Medicine, Old Westbury, NY
    Search for articles by this author

      Abstract

      Wecht JM, Rosado-Rivera D, Handrakis JP, Radulovic M, Bauman WA. Effects of midodrine hydrochloride on blood pressure and cerebral blood flow during orthostasis in persons with chronic tetraplegia.

      Objective

      To determine the mean arterial pressure (MAP) and middle cerebral artery mean blood flow velocity (MFV) responses to 5 and 10mg midodrine during head-up tilt (HUT) in persons with tetraplegia.

      Design

      Prospective dose-response trial.

      Setting

      James J. Peters Veterans Administration Medical Center.

      Participants

      Persons (N=10) with chronic tetraplegia (duration of injury=23±11y).

      Intervention

      A dose titration study was performed over 3 testing days: control (no drug), 5mg midodrine (5mg), or 10mg midodrine (10mg) during 30 minutes of baseline (predrug/no drug), 30 minutes of supine rest postdrug/no drug, 15 minutes of progressive HUT (5 minutes at 15°, 25°, 35°), and 45 minutes of 45° HUT.

      Main Outcome Measures

      MAP and MFV response to midodrine supine and during HUT.

      Results

      Ten milligrams of midodrine significantly increased MAP while supine and during the HUT maneuver. Of note, the mean increase in MAP during HUT with 10mg was a result of a robust effect in 2 persons, with minimal change in the remaining 8 study subjects. The reduction in cerebral MFV during HUT was attenuated with 10mg.

      Conclusions

      These findings suggest that midodrine 10mg may be efficacious for treatment of hypotension and orthostatic hypotension in select persons with tetraplegia. Although midodrine is routinely prescribed to treat orthostatic hypotension, the results of our work suggests limited efficacy of this agent, but additional studies in a larger sample of subjects with spinal cord injury should be performed.

      Key Words

      List of Abbreviations:

      AD (autonomic dysreflexia), CBF (cerebral blood flow), HUT (head-up tilt), MAP (mean arterial pressure), MCA (middle cerebral artery), MFV (mean blood flow velocity), OH (orthostatic hypotension), SCI (spinal cord injury), TCD (transcranial Doppler)
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