Standing and Supine Blood Pressure Outcomes Associated With Droxidopa and Midodrine in Patients With Neurogenic Orthostatic Hypotension: A Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials

@article{Chen2018StandingAS,
  title={Standing and Supine Blood Pressure Outcomes Associated With Droxidopa and Midodrine in Patients With Neurogenic Orthostatic Hypotension: A Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials},
  author={Jack J. Chen and Yi Han and Jonathan Tang and Iv{\'a}n Burgos Portillo and Robert A. Hauser and Khashayar Dashtipour},
  journal={Annals of Pharmacotherapy},
  year={2018},
  volume={52},
  pages={1182 - 1194}
}
Background: The comparative effects of droxidopa and midodrine on standing systolic blood pressure (sSBP) and risk of supine hypertension in patients with neurogenic orthostatic hypotension (NOH) are unknown. Objective: To perform a Bayesian mixed-treatment comparison meta-analysis of droxidopa and midodrine in the treatment of NOH. Methods: The PubMed, CENTRAL, and EMBASE databases were searched up to November 16, 2016. Study selection consisted of randomized trials comparing droxidopa or… 
Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
TLDR
The pathophysiology and clinical characteristics of neurogenic orthostatic hypotension and neurogenic supine hypertension are reviewed, and a stepwise treatment approach is presented to help guide neurologists in managing patients with both nOH and nSH.
Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension.
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Treating nOH in patients with cardiovascular conditions requires a balance between symptom relief and minimizing adverse outcomes, and droxidopa or midodrine may be effective.
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The authors review the effects of droxidopa in NOH with a focus on the neurodegenerative diseases PD, MSA, and pure autonomic failure (PAF, where results appear essentially similar) and indicates a positive yet short-lasting effect of the drug on OH Questionnaire composite score, light-headedness/dizziness score, and standing BP during the first two treatment-weeks.
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Neurogenic orthostatic hypotension (nOH) is a sustained reduction in blood pressure (BP) upon standing that is caused by autonomic dysfunction and is common among patients with a variety of
Management of coexistent neurogenic orthostatic hypotension and supine hypertension
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TLDR
Treating patients with neurogenic orthostatic hypotension who also has supine hypertension should be effectively managed through an integrated therapeutic approach, such as the one used in the following case.
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Collaboration between neurologists and cardiologists is an efficient method to improve outcomes for patients with nOH because this care model allows specialist providers to leverage their areas of expertise to manage the wide spectrum of clinical features associated with n OH.
Orthostatic hypotension in older people: considerations, diagnosis and management.
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In summary, orthostatic hypotension (and associated supine hypertension) are common, dangerous and disabling, but adherence to simple structures management strategies can result in major improvements.
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TLDR
Droxidopa is well tolerated and effective at reducing the symptoms associated with neurogenic orthostatic hypotension without increasing the risk of supine hypertension.
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A 10-mg dose of midodrine prescribed two to three times daily is effective in increasing orthostatic blood pressure and ameliorating symptoms in patients with NOH.
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TLDR
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TLDR
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TLDR
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