Authors: Pathak, Atul; Senard, Jean-Michel

Source: Expert Review of Cardiovascular Therapy, Volume 2, Number 3, May 2004 , pp. 393-403(11)

Publisher: Expert Reviews

Abstract:

Orthostatic hypotension is highly prevalent in the elderly, and affects up to 20% of patients with Parkinson’s disease. Pharmacological approaches help to demonstrate that Parkinson’s disease is a primary autonomic failure with involvement of the peripheral autonomic nervous system as shown by decreased [¹²³I] meta-iodobenzylguanidine cardiac uptake and preserved growth hormone response to clonidine. No specific clinical trial has evaluated efficacy of antihypotensive drugs in Parkinson’s disease. End point of treatment should be a reduction in postural symptoms. Midodrine (Proamatin^®, Roberts Pharmaceutical), a vasoconstrictor and fludrocortisone (Florinef^®, Bristol–Myers Squibb), a volume expander are first choice drugs. No data are available on their effects on orthostatic hypotension-related morbidity. The usefulness of other drugs remains to be demonstrated. This review will highlight the importance of nonpharmacological measures in the management of orthostatic hypotension in Parkinson’s disease.

Keywords: fludrocortisone; midodrine; nonpharmacological measures; orthostatic hypotension; peripheral autonomic failure

Document Type: Research article

DOI: http://dx.doi.org/10.1586/14779072.2.3.393

Publication date: 2004-05-01

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• Expert Review of Cardiovascular Therapy provides expert commentary on the clinical applications of the new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage inculdes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery.
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