Abstract
1092 In patients with pure autonomic failure (PAF), mean arterial pressure (MAP) falls during and after exercise due to inadequate sympathetic restraint of metabolic vasodilation. PURPOSE: To test the hypothesis that midodrine, an oral alpha-1 adrenergic receptor agonist, would attenuate exercise-induced hypotension. Methods: In 14 subjects with PAF, MAP (radial artery catheter) and cardiac output (CO, acetylene uptake) were measured during supine cycling at 25, 50, and 75 watts before and after oral midodrine (10 mg). Results: Midodrine increased resting MAP, sustained greater MAP throughout exercise, and caused MAP to recover faster after exercise (P < 0.05, drug-by-time interaction). CO rose modestly with exercise, and was unaffected by midodrine. Conclusion: Midodrine increases vascular resistance during exercise and markedly improves post exercise blood pressure recovery, which may affect quality of life in PAF. Support: NS- 32352, HL-62692, K23-RR017520, GCRC RR-00585.Figure
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