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August 6, 1997

Efficacy of Midodrine for Neurogenic Orthostatic Hypotension-Reply

Author Affiliations

Rochester, Minn
Finch University of Health Sciences/ The Chicago Medical School North Chicago, Ill
Beth Israel-Deaconess Medical Center Boston, Mass
Roberts Pharmaceutical Corp Eatontown, NJ

JAMA. 1997;278(5):388. doi:10.1001/jama.1997.03550050050029

In Reply.  —Dr Berlin raises several important questions regarding the size and design of our study.First, the data presented in Figures 2 and 3 of our article were based on intention-to-treat analysis. When the dropouts were excluded, the statistical significance for improvement in standing systolic blood pressure remains the same (ie, P<.001),but the scores for lightheadedness (Figure 3) become P=.01 and P=.02 for visits 4 and 5, respectively.Second, Berlin is quite right that it would be interesting and important to know the status of the blood pressure and symptoms at different times after a dose of midodrine. Our multicenter study involving the large number of centers wasmore appropriately focused on more limited end points. It was the opinion of the investigators that the questions of duration of action and pharmacokinetics are better answered in a smaller and more focused study. We also have evaluated the duration of action