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Ivan Berlin, MD, PhD
Pitié-Salpêtrière University Hospital Paris, France

JAMA. 1997;278(5):388.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Orthostatic hypotension due to autonomic failure is an incapacitating condition for which treatment, despite various drug interventions (eg, yohimbine, metoclopramide, β-blockers, somatostatin analog) is not yet resolved. Therefore, the encouraging results of the study of Dr Low and colleagues¹ are potentially of great importance. Although the pharmacological efficacy of midodrine, an 1-adrenoceptor agonist, is clearly demonstrated by this trial, the therapeutic effectiveness is not documented as well and is therefore less convincing. There are several important issues.

First, the number of patients included in the study should allow data analysis on an intention-to-treat basis. This approach would be preferable because of the particularly high dropout rate in the midodrine group (22 [27%] of 82 subjects) when compared with the placebo group (5 [5.6%] of 89 subjects). The difference in dropout rate during the 5 weeks of the study is significant (X²=14.44,^P<.001). Would the . . . [Full Text PDF of this Article]

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