[A one-month combined use of selective adrenergic beta 1- and alpha 1-agonists for postprandial hypotension in...

In 1993, we reported the pathophysiology of postprandial hypotension (PPH) in patients with sympathetic dysfunction: a fall of BP resulted from both excess systemic vasodilation and lack of compensatory increase of cardiac output and vascular resistance in the leg arteries. In that article, we showed the beneficial results of combined oral administration of denopamine (a selective beta 1-agonist) and midodrine HCI (a selective alpha 1-agonist) on this condition. The present study was undertaken to further evaluate the efficacy and safety of this agonist combination in autonomic failure (AF) patients with PPH. This was a one-month trial. A total of 13 chronic AF patients received orally 30 mg of denopamine and 12 mg of midodrine three times a day, 30 minutes before each meal. We measured brachial BP every 10 min in the daytime and every 15 min in the nighttime, using a 24-h indirect BP recorder. The combined use of these agonists produced a significant improvement in PPH and maintained a near-normal BP level. In conclusion, the combined administration of denopamine and midodrine three times a day is a well-tolerated and efficacious treatment for PPH.