[Pyridostigmine in the treatment of primary orthostatic hypotension]

Primary orthostatic hypotension (POH) is an uncommon condition. It is defined as a fall in blood pressure of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing up without any other neurological or general illness. It has recently been reported that pyridostigmine is useful in neurogenic orthostatic hypotension.

To know the utility of pyridostigmine in POH.

Since she was a teenager, a 77 woman has suffered dizziness, nausea, blurred vision and generalized weakness that appeared a few minutes after standing up and improved when sitting or lying down. Neurological examination was normal for her age. Blood pressure control showed systolic and diastolic decreases of 37 mmHg. She improved with fludrocortisone, however, this had to be discontinued due to a supine hypertension and peripheral edemas. Low doses of pyridostigmine treatment were initiated, having similar results in blood pressure control and independence level as fludrocortisone, but with fewer side effects.

Acetylcholinesterase inhibition by pyridostigmine seems to enhance ganglionic sympathetic transmission and consequently leads to an increase in peripheral resistances that resulted in blood pressure, above all in the upright position.

Pyridostigmine seems to be as useful as fludrocortisone in the POH treatment and has less side effects. This new strategy may be an alternative or a complement in the treatment of the illness.