Midodrine: underrated medication

Midodrine, a peripheral selective alpha-1-adrenergic agonist, is medication for the treatment of orthostatic hypotension (OH) with a prevalent qualified decrease in diastolic blood pressure (DBP) and accompanying syncope reactions

OH ordinary occurs upon at a sharp transition to a vertical position (orthostasis) and can occupy some period of time 

OH is a result of an inadequate physiologic response to postural changes in blood pressure 

OH is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in DBP of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position

OH may be acute or chronic, as well as symptomatic or asymptomatic

A decrease in DBP has various causes, most often age-related atherosclerotic stiffening of the arteries and/or prolonged taking of certain sets of medications that lead to impaired peripheral arterial baroreceptor control with a dramatically decreased peripheral vascular resistance

The criterion of a qualified decrease in DBP is its fall down below 60 mm Hg at a sharp transition to a vertical position 

If medications are the cause of orthostatic diastolic hypotension, they should be canceled 

When violations of the baroreceptor control cause a decrease in peripheral vascular resistance with a sharp drop in diastolic blood pressure, it is necessary to prescribe midodrine if it is not contraindicated

Caution: the last dose should not be taken after 6:00 p.m. to avoid supine hypertension  

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