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Midodrine for Orthostatic Hypotension: A Systematic Review and Meta-Analysis of Clinical Trials

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ABSTRACT

OBJECTIVE

To perform a systematic review and meta-analysis of clinical trials evaluating the efficacy and safety of midodrine in orthostatic hypotension (OH).

METHODS

We searched major databases and related conference proceedings through June 30, 2012. Two reviewers independently selected studies and extracted data. Random-effects meta-analysis was used to pool the outcome measures across studies.

RESULTS

Seven trials were included in the efficacy analysis (enrolling 325 patients, mean age 53 years) and two additional trials were included in the safety analysis. Compared to placebo, the mean change in systolic blood pressure was 4.9 mmHg (p = 0.65) and the mean change in mean arterial pressure from supine to standing was −1.7 mmHg (p = 0.45). The change in standing systolic blood pressure before and after giving midodrine was 21.5 mmHg (p < 0.001). A significant improvement was seen in patients’ and investigators’ global assessment symptoms scale (a mean difference of 0.70 [95 % CI 0.30–1.09; p < 0.001] and 0.80 [95 % CI 0.76–0.85; p < 0.001], respectively). There was a significant increase in risk of piloerection, scalp pruritis, urinary hesitancy/retention, supine hypertension and scalp paresthesia after giving midodrine. The quality of evidence was limited by imprecision, heterogeneity and increased risk of bias.

CONCLUSION

There is insufficient and low quality evidence to support the use of midodrine for OH.

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Acknowledgments

We would like to thank Dr. Christian Jeng-Singh (Mayo Clinic, Rochester, MN) for his help in the translation of the German articles.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 200 1st street, SW, Rochester, MN, 55905, USA

    Ajay K. Parsaik MD & Balwinder Singh MD

  2. Knowledge and Evaluation Research, Mayo Clinic, Rochester, MN, 55905, USA

    Osama Altayar MD, Patricia J. Erwin & M. Hassan Murad MD, MPH

  3. Health Care Management, London Training College, London, UK

    Soniya S. Mascarenhas RN

  4. Department of General Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Shannon K. Singh

  5. Division of Preventive Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Osama Altayar MD & M. Hassan Murad MD, MPH

Authors
  1. Ajay K. Parsaik MD
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  2. Balwinder Singh MD
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  3. Osama Altayar MD
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  4. Soniya S. Mascarenhas RN
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  5. Shannon K. Singh
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  6. Patricia J. Erwin
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  7. M. Hassan Murad MD, MPH
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Corresponding author

Correspondence to Ajay K. Parsaik MD.

Additional information

Ajay K. Parsaik and Balwinder Singh contributed equally to this manuscript.

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Parsaik, A.K., Singh, B., Altayar, O. et al. Midodrine for Orthostatic Hypotension: A Systematic Review and Meta-Analysis of Clinical Trials. J GEN INTERN MED 28, 1496–1503 (2013). https://doi.org/10.1007/s11606-013-2520-3

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  • DOI: https://doi.org/10.1007/s11606-013-2520-3

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