Treatment of diabetic orthostatic hypotension with pindolol

The hemodynamic variables, plasma noradrenaline and plasma renin concentrations were studied in a 57-year-old female with insulin-dependent diabetes of long-standing and orthostatic hypotension. For 6 months she had been bedridden because of severe orthostatic symptoms. Reflex responses in the heart rate and blood pressure during the Valsalva manoeuvre as well as beat-to-beat variations in heart rate were absent. Plasma noradrenaline concentrations were subnormal both in the supine and upright positions. After treatment with Pindolol 15 mg/day the patient was able to walk around and lead an almost normal life. The orthostatic symptoms recurred after withdrawal of therapy and disappeared on resumption of therapy. Arterial blood pressure measured intra-arterially decreased less in the up-right position during treatment with pindolol compared to that in the untreated condition. The heart rate did not change during treatment with Pindolol. Our findings suggest that Pindolol may be an important drug in the treatment of diabetic orthostatic hypotension.