Key result
Midodrine administration in heart failure patients with symptomatic hypotension allowed for significant up-titration of ACEI/ARB therapy from 20% to 57.5% of optimal dose (P<.001).
Why the study?
Does midodrine improve the ability to up-titrate neurohormonal antagonist therapy and clinical outcomes in patients with heart failure and symptomatic hypotension?
Observational (n=10)
Does midodrine improve the ability to up-titrate neurohormonal antagonist therapy and clinical outcomes in patients with heart failure and symptomatic hypotension?
Absolute Event Rate: 57.5% vs 20%
p-value: p=<.001
Midodrine may facilitate the up-titration of guideline-directed medical therapy in heart failure patients with symptomatic hypotension, leading to improved ejection fraction and reduced hospitalizations.
May allow GDMT up-titration in hypotensive HF; leaves open effects on outcomes.
In many patients, the treatment of heart failure (HF) cannot be optimized because of pre-existing or treatment-induced hypotension. Midodrine, a peripheral alpha1-adrenergic agonist may allow for up-titration of neurohormonal antagonist therapy leading to improved outcomes. Ten consecutive patients with HF due to systolic dysfunction and symptomatic hypotension interfering with optimal medical therapy were started on midodrine. After a 6-month follow-up, a higher percentage of patients were on optimal HF therapy (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker mg % of optimal dose 20% vs 57.5%; P<.001) (beta-blockers mg % optimal dose 37.5% vs 75%; P<.001) (spironolactone/eplerenone mg % 43.7% vs 95%; P<.001). This led to an improvement in left ventricular ejection fraction (baseline 24+/-9.4 vs 32.2+/-9.9; P<.001) and clinical outcomes, with a significant reduction in total hospital admissions (32 vs 12; P=.02) and total hospital days (150 vs 58; P=.02).
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Zakir et al. (2009) conducted an observational in Heart failure with systolic dysfunction and symptomatic hypotension (n=10). Midodrine vs. Baseline was evaluated on ACEI/ARB % of optimal dose (p=<.001). Midodrine administration in heart failure patients with symptomatic hypotension allowed for significant up-titration of ACEI/ARB therapy from 20% to 57.5% of optimal dose (P<.001).
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