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Midodrine for orthostatic hypotension and recurrent reflex syncope: A systematic review
Abstract
OBJECTIVE: Symptomatic orthostatic hypotension (SOH) and recurrent reflex syncope (RRS) can be disabling. Midodrine has been proposed in the management of patients with these conditions but its impact on patient important outcomes remains uncertain. We performed a systematic review to evaluate the efficacy and safety of midodrine in patients with SOH and RRS. METHODS: We searched multiple electronic databases without language restriction from their inception to June 2013. We included randomized controlled trials of patients with SOH or RRS that compared treatment with midodrine against a control and reported data on patient important outcomes. We graded the quality of evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS: Eleven trials involving 593 patients were included in this review. Three studies addressed health-related quality of life in patients with RRS, showing improvement with midodrine: risk difference 14% (95% confidence interval [CI] -3.5 to 31.6), very low confidence. Seven studies addressed symptom improvement and provided poolable data showing improvement with midodrine in patients with SOH: risk difference 32.8% (95% CI 13.5-48), low confidence; and RRS: risk difference 63.3% (95% CI 47.6-68.2), very low confidence. Five studies reported syncope recurrence in patients with RRS showing improvement with midodrine: risk difference 37% (95% CI 20.8%-47.4%), moderate confidence. The most frequent side effects in the midodrine arm were pilomotor reactions (33.6%, risk ratio 4.58 [95% CI 2.03-10.37]). CONCLUSIONS: Evidence warranting low/moderate confidence suggests that midodrine improves clinical important outcomes in patients with SOH and RRS.
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In the citing paper
“A recent systematic review of these trials 278 showed that the confidence in estimates was moderate because of imprecision and publication bias.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [278]
In the citing paper
“Direct a1-adrenoreceptor agonist.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [94]
In the citing paper
“One of the few pharmacological agents positively tested in placebo-controlled studies for orthostatic hypotension.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [94]
In the citing paper
“It may be effective in 'hypovolaemic' subtype and low-BP phenotype with pronounced orthostatic intolerance.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [94]
Citations
Cites
GRADE guidelines: 3. Rating the quality of evidence
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., & Norris, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.015 · Cited by 8,285
GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias)
Guyatt, G. H., Oxman, A. D., Vist, G., Kunz, R., Brozek, J., Alonso-Coello, P., Montori, V., Akl, E. A., Djulbegovic, B., & Falck-Ytter, Y. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.017 · Cited by 2,798
Self-citationGRADE guidelines 6. Rating the quality of evidence—imprecision
Guyatt, G. H., Oxman, A. D., Kunz, R., Brozek, J., Alonso-Coello, P., Rind, D., Devereaux, P. J., Montori, V. M., Freyschuss, B., Vist, G., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.01.012 · Cited by 2,693
Self-citationGRADE guidelines: 7. Rating the quality of evidence—inconsistency
Guyatt, G. H., Oxman, A. D., Kunz, R., Woodcock, J., Brozek, J., Helfand, M., Alonso-Coello, P., Glasziou, P., Jaeschke, R., Akl, E. A., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.03.017 · Cited by 2,320
Self-citationDeveloped in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
GRADE guidelines: 8. Rating the quality of evidence—indirectness
Guyatt, G. H., Oxman, A. D., Kunz, R., Woodcock, J., Brozek, J., Helfand, M., Alonso-Coello, P., Falck-Ytter, Y., Jaeschke, R., Vist, G., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.04.014 · Cited by 1,843
Self-citationGRADE guidelines: 5. Rating the quality of evidence—publication bias
Guyatt, G. H., Oxman, A. D., Montori, V., Vist, G., Kunz, R., Brozek, J., Alonso-Coello, P., Djulbegovic, B., Atkins, D., Falck-Ytter, Y., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.01.011 · Cited by 1,819
Self-citationGRADE guidelines: 13. Preparing Summary of Findings tables and evidence profiles—continuous outcomes
Guyatt, G. H., Thorlund, K., Oxman, A. D., Walter, S. D., Patrick, D., Furukawa, T. A., Johnston, B. C., Karanicolas, P., Akl, E. A., Vist, G., et al. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.08.001 · Cited by 772
Self-citationLow, P. A. (1997) · JAMA · doi:10.1001/jama.1997.03540370036033 · Cited by 425
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Metadata
- Authors
- Izcovich, A., González Malla, C., Manzotti, M., Catalano, H. N., & Guyatt, G.
- Affiliations
- Hospital Alemán (AR)
- From the Internal Medicine Department (A.I., C.G.M., M.M., H.N.C.), Hospital Alemán, Buenos Aires, Argentina; and Department of Clinical Epidemiology and Biostatistics (G.G.), McMaster University, Hamilton, Canada.
- Venue
- Neurology
- Published
- 2014-09-23
- Volume
- 83
- Issue
- 13
- Pages
- 1170-1177
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2075653249
- Cited by
- 131
- References
- 39
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 13 · 2021: 23 · 2020: 9 · 2019: 14 · 2018: 11 · 2017: 11 · 2016: 20 · 2015: 11
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- midodrine, orthostatic hypotension, reflex syncope, recurrent syncope, health-related quality of life, symptom improvement, syncope recurrence, drug safety, vasopressor therapy
- MeSH terms
- Humans, Hypotension, Orthostatic, Midodrine, Quality of Life, Reflex, Syncope, Secondary Prevention
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