Patients with a condition called orthostatic hypotension have problems with sinking blood pressure when standing up from a sitting position. Current treatments help increase blood pressure when standing but also cause blood pressure to soar when lying down, increasing the risk for stroke. Researchers say that a new drug application could help patients with low blood pressure.
Blood pressure control lessens with age, making orthostatic hypotension especially common in those over age 70. Common causes of the condition include diabetes, autonomic neuropathy, multiple system atrophy, pure autonomic failure, and Parkinson's disease. Drugs used to control blood pressure are often catalysts for orthostatic hypotension.
A recent study reveals that the drug pyridostigmine, also known as Mestinon or Mestinon Timespan, could be the answer. Pyridostigmine has been used for years to treat myasthenia gravis, a neuromuscular disease. The drug works at the level of the autonomic ganglion, which has minimal nerve signaling traffic when lying down. When standing up, however, nerve signaling traffic in the autonomic ganglion increases. Researchers theorized a drug that affects the autonomic ganglion would improve nerve transmission for orthostatic hypotension patients and trigger the reflex that controls blood pressure in all positions.
Researchers studied 58 patients. Patients either received a placebo, pyridostigmine alone, or pyridostigmine in combination with one of two low dosages of midodrine (ProAmatine), a drug known to improve orthostatic hypotension. Researchers measured the effects of the drugs one hour post-treatment. Pyridostigmine significantly improved the patients' standing blood pressure without raising blood pressure lying down. The positive effects of the drug were further improved when combined with low-dose midodrine. Side effects were mild, including some abdominal cramping or the need to use the bathroom more than usual. A follow-up occurred two years after the trial. Information was available on 32 of the patients, and 75 percent reported either good or excellent results from the pyridostigmine treatment. About 25 percent used pyridostigmine alone, and about 33 percent needed a lower dose of another medication. Researchers conclude saying that in the future more study needs to be done in this area .