Fludrocortisone for orthostatic hypotension
Evidence for the effects of fludrocortisone on blood pressure, orthostatic symptoms, or adverse events in people with orthostatic hypotension and diabetes mellitus or Parkinson's disease is very uncertain. There is a lack of information on the long-term treatment and cure of orthostatic hypotension in other medical conditions. Standardized reporting of results and standardization of blood pressure measurement in orthostatic hypotension are needed.
Veazie S, Peterson K, Ansari Y, Chung KA, Gibbons CH., Raj SR, HelfandM. Fludrocortisone for orthostatic hypotension. Cochrane Database of Systematic Reviews 2021, No. 5. Art. No.: CD012868. doi: 10.1002 /14651858.CD012868.pub2. Accessed May 18, 2021.
Commentary
Orthostatic hypotension is a condition that can lead to a drop in blood pressure when shifting postures, and symptomatic orthostatic hypotension with regular symptoms can be considered an abnormal physical response. Symptomatic orthostatic hypotension is also an abnormal physical reaction. It can be caused by medication, dehydration, poor health, or age, as the heart may not be able to supply enough blood to the brain, all of which are common in people over 65.
The study reviewed involved medication treatment with fludrocortisone acetate, which is an artificial steroid that increases blood volume and improves the ability of blood vessels to respond to changes in position. Common medications for orthostatic hypotension include midodrine and droxidopa, although indications may also be prescribed for high blood pressure, swelling, congestive heart failure, low potassium (blood salts), headache, insomnia, and increased sweating.
The study.
reviewed 13 studies involving 513 participants and found that fludrocortisone reduced blood pressure lowering compared to placebo (an inactive drug) in people with severe diabetic neuropathy or compared to a drug called pyridostigmine when used in people with Parkinson's disease, according to the results of the randomized study.
However, based on the current limitations of the available evidence, it is stated that no firm conclusions can be drawn about the use of fludrocortisone for "orthostatic hypotension" in people with diabetes or Parkinson's disease.
