Key result
Ivabradine plus cardiac rehab shows 6-month symptom improvement in severe orthostatic hypotension.
Why the study?
Orthostatic hypotension carries increased morbidity and mortality with limited treatment options, especially when unresponsive to usual care.
Does ivabradine improve symptoms and upright tolerance in a patient with stable ischemic heart disease and severe orthostatic hypotension?
Case Report (n=1)
Does ivabradine improve symptoms and upright tolerance in a patient with stable ischemic heart disease and severe orthostatic hypotension?
Ivabradine may be a successful adjunctive treatment to enable cardiac rehabilitation and ACE inhibitor titration in patients with highly disabling orthostatic hypotension.
SUMMARY: Orthostatic hypotension (OH) is a disabling condition accompanying several diseases. It has increased morbidity and mortality, and limited chances of treatment. We report a case of a patient with stable ischemic heart disease and severe OH unresponsive to usual care. A baseline 75° head-up tilt test (HUT) was positive for symptomatic OH, i.e. pre-syncope with a systolic arterial pressure drop of 35 mmHg. On top of optimal treatment, ivabradine was started. Symptoms improved within 24 hours. At a repeated HUT, the patient could tolerate the up-right position up to 25 minutes. He was able to undergo an individualized training program with further amelioration of quality of life. Thereafter, titration of ACE inhibitors became possible. Lasting benefits were present at a 6-month follow-up. To our knowledge, this is the first reported case of successful use of ivabradine to integrate cardiac rehabilitation for management of a highly disabling OH.
No takes yet. Share an insight, caveat, or question.
Vecchia et al. (2025) conducted a case report in Orthostatic hypotension and stable ischemic heart disease (n=1). Ivabradine and cardiac rehabilitation was evaluated on Symptomatic improvement and tolerance of up-right position during head-up tilt test. Ivabradine combined with cardiac rehabilitation improved severe orthostatic hypotension symptoms within 24 hours and allowed upright tolerance for up to 25 minutes, with benefits lasting at 6 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: