Article

OBJECTIVE: To determine the mean arterial pressure (MAP) and middle cerebral
artery mean blood flow velocity (MFV) responses to 5 and 10mg midodrine during
head-up tilt (HUT) in persons with tetraplegia. DESIGN: Prospective dose-response
trial. SETTING: James J. Peters Veterans Administration Medical Center.
PARTICIPANTS: Persons (N=10) with chronic tetraplegia (duration of injury=23+/-11 y).
A dose titration study was performed over 3 testing days:
control (no drug), 5mg midodrine (5mg), or 10mg midodrine (10mg) during 30
minutes of baseline (predrug/no drug), 30 minutes of supine rest postdrug/no
drug, 15 minutes of progressive HUT (5 minutes at 15 degrees , 25 degrees , 35
degrees ), and 45 minutes of 45 degrees HUT. MAIN OUTCOME MEASURES: MAP and MFV
response to midodrine supine and during HUT. RESULTS: Ten milligrams of midodrine
significantly increased MAP while supine and during the HUT maneuver. Of note,
the mean increase in MAP during HUT with 10mg was a result of a robust effect in
2 persons, with minimal change in the remaining 8 study subjects. The reduction
in cerebral MFV during HUT was attenuated with 10mg. CONCLUSIONS: These findings
suggest that midodrine 10mg may be efficacious for treatment of hypotension and
orthostatic hypotension in select persons with tetraplegia. Although midodrine is
routinely prescribed to treat orthostatic hypotension, the results of our work
suggests limited efficacy of this agent, but additional studies in a larger
sample of subjects with spinal cord injury should be performed.

Langue : ANGLAIS