hypotension

[churchill2]

i suffer from hypotention usualy (my usual blood pressure is 90/50) and may even get lower
i take mididrine HCL but i fear that it could develop later cardiomyopathy

is my fear is true
and how cound i manage my hypotension with medications without fear from later bad consequences

iam a 21 years old male

[Doctor]

Dear churchill2,

Thank you for your question.

Midodrine has been commercially available for 2-3 years and is used to treat orthostatic hypotension (related to standing).

Midodrine is an alpha-agonist that acts on smooth muscle cells in arteries to increase blood pressure and reduce the symptoms associated with orthostatic hypotension. But, this medication should only be used during the day when you are standing. If used at night while you are recumbent, it could dangerously elevate your blood pressure.

Mechanism of Action: Midodrine forms an active metabolite, desglymidodrine, that is an alpha1-agonist, and exerts its actions via activation of the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure. Desglymidodrine does not stimulate cardiac beta-adrenergic receptors. Desglymidodrine diffuses poorly across the blood-brain barrier, and is therefore not associated with effects on the central nervous system.

Administration of midodrine results in a rise in standing, sitting, and supine systolic and diastolic blood pressure in patients with orthostatic hypotension of various etiologies. Standing systolic blood pressure is elevated by approximately 15 to 30 mmHg at 1 hour after a 10 mg dose of midodrine, with some effect persisting for 2 to 3 hours. Midodrine has no clinically significant effect on standing or supine pulse rates in patients with autonomic failure.

Typical side effects are headaches, visual disturbances, and difficulty urinating. However, you should check with your own physician regarding all of your questions before starting such a medication.

I don't know about your location and not sure whether this facility is available in your area or not anyway there is tilt table test is used to determine the cause of orthostatic hypotension. During this test, a patient is on a table that tilts upright at 60 degrees for prolonged periods of time to try to induce fainting spells. The heart rate, ECG, and blood pressure are continuously recorded while the test is ongoing.

If there is no response to the initial tilt, a medication called isuprel is used to speed up the heart rate to try to induce a fainting spell. If fainting is induced, it usually resolves quickly since the test is terminated once this happens.

You might have couple of questions in your mind you can visit this link for more detail

Midodrine HCL (midodrine hydrochloride)

I hope you find this information useful. Please feel free to write back with additional questions.

Good Luck.

[churchill2]

dear doctor,

thank u so much for ur great information

but i still have questions

1- is there is a bad consequences on the heart if i used a blood pressure elevationg drug
2- i usually suffer from slurred speech ,is this due to my low blood pressure

thank u

[Hero]

Originally Posted by Doctor

Midodrine is an alpha-antagonist that acts on smooth muscle cells in arteries to increase blood pressure and reduce the symptoms associated with orthostatic hypotension.

Midodrine is an alpha-agonist not antagonist. Alpha-antagonist induces vasodilation. This is a good drug for orthostatic hypotension, but I haven't seen any young guy of 21 yrs old having orthostatic hypotension. Your BP is usually 90/50 mmHg doesn't mean that u have orthostatic hypotension.
Usually tilt test is done for syncope, and I dont suggest for tilt test to rule out orthostatic hypotension, this can be diagnosed in the OPD. There are few cases where patient had died, or got brain damage during tilt test. (though only few cases in literature). Measure BP in supine and erect position, if it decreases in erect position then we can consider orthostatic hypotension. U need further evaluation, or it could be normal if you are asymptomatic. U don't need any drug for 90/50. Take more salt and water. Squeeze your leg while sitting, use Crepe bandage in ur lower limbs. This should be the primary management in young patients with hypotension. There is no case report of cardiomyopathy due to midodrine use, but just need to monitor ur BP, dont let it too high. Slurred speech could be due to weakness. Consume more fruits, salt and water.

[churchill2]

Originally Posted by Hero

Midodrine is an alpha-agonist not antagonist. Alpha-antagonist induces vasodilation. This is a good drug for orthostatic hypotension, but I haven't seen any young guy of 21 yrs old having orthostatic hypotension. Your BP is usually 90/50 mmHg doesn't mean that u have orthostatic hypotension.
Usually tilt test is done for syncope, and I dont suggest for tilt test to rule out orthostatic hypotension, this can be diagnosed in the OPD. There are few cases where patient had died, or got brain damage during tilt test. (though only few cases in literature). Measure BP in supine and erect position, if it decreases in erect position then we can consider orthostatic hypotension. U need further evaluation, or it could be normal if you are asymptomatic. U don't need any drug for 90/50. Take more salt and water. Squeeze your leg while sitting, use Crepe bandage in ur lower limbs. This should be the primary management in young patients with hypotension. There is no case report of cardiomyopathy due to midodrine use, but just need to monitor ur BP, dont let it too high. Slurred speech could be due to weakness. Consume more fruits, salt and water.

thanks Dr hero

but if i let my blood pressure 90/50 without medical intervension,can this affect the heart in future ?

[Hero]

Asymptomatic hypotension in young usually do not need any treatment except high salt n water intake, lower limb crepe bandage. If not improved by these measures, or if you develop symptoms of low blood pressure, then obviously need to identify the cause and you should take medicines.