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December 4, 1987

Phenylpropanolamine in Patients With Autonomic Impairment

JAMA. 1987;258(21):3121. doi:10.1001/jama.1987.03400210063021

To the Editor.—  The study entitled "The Potent Pressor Effect of Phenylpropanolamine in Patients With Autonomic Impairment" by Biaggioni et al1 has several serious flaws. First, there is no placebo arm. Before we can accept the authors' conclusion that "phenylpropanolamine [hydrochloride] is a potent pressor agent in patients with impaired autonomic function," we need to ask if a placebo might yield the same result. Reading the "Methods" section, one can picture the 14 study patients with autonomic dysfunction, hooked to monitors in a clinical research center, nervously swallowing pills they are told might raise their blood pressure. Indeed, the principles of informed consent would compel the investigators to disclose even more serious side effects that might occur. Blood pressure is too variable a physiological entity, and placebos too potent, for us to be certain that phenylpropanolamine was the major pressor in this study.Second, the investigators measured only seated