Clinical trial of home blood pressure monitoring following midodrine administration in hypotensive individuals with spinal cord injury

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2021.1977904 · Published: July 1, 2023

Spinal Cord Injury Cardiovascular Science Neurology

Simple Explanation

This study investigated the effects of midodrine, a medication used to raise blood pressure, on individuals with spinal cord injury (SCI) who experience low blood pressure. The research aimed to understand how midodrine affects blood pressure, adverse events, and symptom reporting in these individuals over a 30-day period at home. Participants were given either midodrine or a placebo, and their blood pressure was monitored regularly. The study looked at average blood pressure, fluctuations in blood pressure, and symptoms related to autonomic dysreflexia (AD) and orthostatic hypotension (OH). The results showed that midodrine increased blood pressure and reduced hypotension but also worsened blood pressure instability and increased the intensity of AD symptoms. This suggests that while midodrine can raise blood pressure, it may also have negative side effects that need to be considered.

Study Duration

30-day monitoring periods

Participants

19 individuals with SCI

Evidence Level

Randomized, placebo-controlled, double-blinded clinical trial

Key Findings

1
Midodrine significantly increased average 30-day systolic and diastolic blood pressure compared to placebo.
2
Midodrine significantly reduced the number of hypotensive blood pressure recordings compared to placebo.
3
Midodrine increased fluctuations in blood pressure and worsened the intensity of symptoms associated with autonomic dysreflexia.

Research Summary

The study evaluated the effects of midodrine on blood pressure (BP) in hypotensive individuals with spinal cord injury (SCI) during a 30-day home monitoring period. Midodrine increased average BP and reduced the incidence of hypotension, but also worsened BP instability and autonomic dysreflexia (AD) symptom intensity. The findings suggest the need for close ambulatory BP monitoring and symptom recording during daily activities before long-term midodrine prescription in SCI patients.

Practical Implications

Clinical Monitoring

Close ambulatory monitoring of blood pressure is necessary when prescribing midodrine to individuals with SCI.

Symptom Management

Healthcare providers should be aware of the potential for worsened autonomic dysreflexia symptoms when using midodrine.

Further Research

Further studies are needed to investigate varied doses of midodrine and alternative treatments for hypotension in the SCI population.

Study Limitations

1
Small sample size of 19 participants limits generalizability.
2
Blood pressure monitoring was performed periodically, potentially under-reporting instability.
3
Lack of a generally accepted target normotensive range for SCI individuals.

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