Effect of Midodrine vs Abdominal Compression on Cardiovascular Risk Markers in Autonomic Failure Patients

Inclusion Criteria:

• Male and female subjects, age 40-80 years, with autonomic failure including pureautonomic failure, multiple system atrophy and Parkinson disease.

• Neurogenic orthostatic hypotension, defined as a ≥20-mmHg decrease in SBP within 3minutes of standing associated with impaired autonomic reflexes determined byautonomic testing in the absence of other identifiable causes.

• Patients who are willing and able to provide informed consent

Exclusion Criteria:

• Pregnancy.

• Patients with any contraindication or intolerant to abdominal compression includinghistory of aortic aneurysms, thoracic, abdominal or pelvic surgery within 6 monthsof study participation; symptomatic abdominal or inguinal hernias; severegastrointestinal reflux; recent fractures or fissures of ribs, thoracic or lumbarspine; medical devices implanted on the abdominal wall or abdomen that wouldinterfere with the abdominal compression.

• Pre-existing sustained supine hypertension ≥180/110mmHg

• Bedridden patients or those who are unable to stand due to motor impairment orsevere OH.

• Patients who cannot tolerate the medication withdrawal, defined as those who areunable to stand for at least one minute after the medication withdrawal period orthose with sustained supine hypertension ≥180/110mmHg.

• Clinically unstable coronary artery disease, or major cardiovascular or neurologicalevent in the past 6 months.

• Clinically significant pulmonary, renal, hematopoietic, hepatic disease, or otherfactors which in the investigator's opinion would prevent the subject fromcompleting the protocol including clinically significant abnormalities in clinical,mental, or laboratory testing