Midodrine to optimize heart failure therapy in patients with concurrent hypotension

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Paul Shiu1, Gurinder S Grewal2, Teri M Kozik1

  • 1Graduate Medical Education, St. Joseph's Medical Center, Stockton, CA, USA.

SAGE Open Medical Case Reports
|May 23, 2022
PubMed

Insights

Midodrine can help patients with heart failure and low blood pressure start or continue essential treatments. This alpha-agonist therapy improves clinical outcomes, making guideline-directed medical therapy more tolerable.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) affects millions, with Guideline-Directed Medical Therapy (GDMT) as the standard treatment.
  • GDMT includes renin-angiotensin-aldosterone system inhibitors, neprilysin inhibitors, beta-blockers, mineralocorticoid-receptor-antagonists, and SGLT2 inhibitors.
  • Refractory hypotension poses a significant barrier to initiating or continuing GDMT in HFrEF patients.

Observation:

  • Four cases of HFrEF patients with persistent, baseline hypotension are presented.
  • Midodrine, an alpha-adrenergic agonist, was used as a bridge therapy to enable GDMT initiation or continuation.
  • Patients experienced marked clinical improvement with outpatient midodrine titration.

Findings:

  • Midodrine effectively managed refractory hypotension in HFrEF patients.
  • This intervention facilitated the initiation and continuation of GDMT.
  • Clinical exacerbations of HFrEF were ameliorated, improving GDMT tolerability.

Implications:

  • Midodrine can be a valuable tool for managing HFrEF patients with concomitant hypotension.
  • It enables the use of life-saving GDMT in a previously challenging patient population.
  • Outpatient midodrine titration may improve long-term outcomes for hypotensive HFrEF patients.

Keywords:
Midodrinedose titrationguide directed medical therapyheart failure

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