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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
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Thiazide diuretics are sulfonamide derivatives featuring a benzothiadiazine ring system in their molecular structure. Based on this structure, thiazide diuretics can be categorized into two groups: thiazide-type and thiazide-like diuretics. Thiazide-type diuretics, including hydrochlorothiazide and chlorothiazide, consist of a benzothiadiazine backbone with an attached sulfonamide group. Thiazide-like diuretics, such as chlorthalidone and indapamide, lack the thiazide ring but demonstrate...
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Fludrocortisone for orthostatic hypotension.

Stephanie Veazie1, Kim Peterson2, Yasmin Ansari3

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The evidence for fludrocortisone in treating orthostatic hypotension is very uncertain. More research is needed to understand its benefits and harms for blood pressure and symptoms.

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Area of Science:

  • Pharmacology
  • Cardiovascular Medicine
  • Neurology

Background:

  • Orthostatic hypotension (OH) involves a significant drop in blood pressure upon standing.
  • Fludrocortisone, a mineralocorticoid, is a common treatment for OH, aiming to increase blood volume and pressure.
  • Current understanding of fludrocortisone's benefits and harms in OH lacks comprehensive review.

Purpose of the Study:

  • To systematically identify and evaluate the benefits and harms of fludrocortisone for treating orthostatic hypotension.
  • To synthesize evidence from randomized controlled trials and observational studies.

Main Methods:

  • Searched multiple databases (Cochrane Neuromuscular, CENTRAL, MEDLINE, Embase, CINAHL) and trials registries up to November 2019.
  • Included RCTs, quasi-RCTs, and observational studies on fludrocortisone for OH, excluding medication-induced or acute causes.
  • Assessed evidence certainty using GRADE and employed a tool to prioritize observational studies.

Main Results:

  • Included 13 studies (3 RCTs, 10 observational) with 513 participants.
  • Evidence for fludrocortisone's effect on blood pressure and orthostatic symptoms in diabetes and Parkinson disease is of very low certainty.
  • Observational studies suggest fludrocortisone may be safe long-term for familial dysautonomia, but long-term efficacy remains unclear.

Conclusions:

  • The current evidence base regarding fludrocortisone's efficacy and safety for orthostatic hypotension in specific conditions like diabetes and Parkinson disease is highly uncertain.
  • There is a significant need for high-quality research, standardized outcome reporting, and consistent blood pressure measurement in OH studies.
  • Further investigation is required to clarify the long-term effects and benefits of fludrocortisone across various causes of orthostatic hypotension.