hyptotension

[J-A-Bem]

  I am a 44 years old female, dx with progressive remitting MS.  I suffer
  from low blood pressure. Laying 86/60, sitting 78/57, standing 63/43
  My pulse rate varies from 96 to 107.  My Doctor says that this related
  to my MS.  Testing, that I have had extensive blood work up checking
  for hypothyoroidism and Echo, have showed normal.  I am currently taking
  Florinef 0.1 mg, two tables, twice daily. For my MS, I am taking Avonex.
  The Florinef does not seem to benefit my blood pressure results.
  Currently, 89/61 laying, 83/58 sitting, 72/48, pluse rate of 92.
  I have experienced fainting and black-outs, increase rise in body tempature
  and and spasm in extemities before taking medication.  With Florinef I tend
  to experience increase fatique, confusion. (temp 99.7), and feeling of
  passing out.
  Doctor is recommending medication that was recently approved durintg the
  last qaurter of 1998.  However, he didn't inform me of the name.
  Could you tell me the name, possible side-effects and result of taking this
  medication.
  I am awaiting approval from my insurance to start taking this new medication.
  I was wondering if my condition could be FMS and if so, would this new
  medication benefit my hypotension and FMS.
  Could you also tell what a tilt table test is.
  I eagerly await your response.

[CCF Cardio MD - MTR]

_
Dear J.A., thank you for your question.  In her response to your question, Dorothy provides some useful information.  It is true that you should increase your salt intake while taking florinef, but it sounds like you've had numerous side effects from this medication that may be intolerable.  The medication you are referring to I believe is called midodrine (which Dorothy also mentions).  Midodrine has been commercially available for 2-3 years and is used to treat orthostatic hypotension (related to standing).  In your case, I believe the MS has affected your autonomic nervous system which regulates blood pressure - thus, you are having refractory hypotension and symptoms related to it.  Midodrine is an alpha-antagonist that acts on smooth muscle cells in arteries to increase blood pressure and reduce the symptoms associated with orthostatic hypotension.  But, this medication should only be used during the day when you are standing.  If used at night while you are recumbent, it could dangerously elevate your blood pressure.  Typical side effects are headaches, visual disturbances, and difficulty urinating.  However, you should check with your own physician regarding all of your questions before starting such a medication.
A tilt table test is used to determine the cause of orthostatic hypotension.  During this test, a patient is on a table that tilts upright at 60 degrees for prolonged periods of time to try to induce fainting spells.  The heart rate, ECG, and blood pressure are continuously recorded while the test is ongoing.  If there is no response to the initial tilt, a medication called isuprel is used to speed up the heart rate to try to induce a fainting spell.  If fainting is induced, it usually resolves quickly since the test is terminated once this happens.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.