Date of Award

5-2021

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Jay Metzger

Keywords

Orthostatic hypotension; Aged; Drug therapy; Therapy; Mortality; Morbidity; Midodrine; Fludrocortisone; Pyridostigmine; Droxidopa

Abstract

The purpose of this literature review is to determine the efficacy and safety of pharmacologic treatments for orthostatic hypotension (OH), with an emphasis on researching the elderly population. In this review, three electronic search databases were utilized including PubMed, Google Scholar, and Dynamed from the years 1997 to 2019. Several keywords were used during the search. Criteria for chosen articles included that the article must be peer-reviewed, the studied population must have a median age of at least 50 years-old, at least 20 subjects must be involved, and the study must be published after the year 1995. The specific pharmacologic agents researched for the treatment of OH included midodrine, droxidopa, pyridostigmine, and fludrocortisone. There were 15 research articles chosen that included randomized control trials, systematic reviews, and meta-analyses. Although midodrine is the most researched and utilized pharmacologic treatment of OH, this drug may not be the best option when it comes to treatment in the elderly population due to an increase in supine hypertension. Pyridostigmine in combination with low-dose midodrine was found to be effective in relieving OH symptoms without increasing supine hypertension, but this evidence is based on limited randomized trials. More research is still needed to evaluate the efficacy and safety of these pharmacologic measures in the treatment of OH specifically in the elderly population and over a long period of time.

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