{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:28:29Z","timestamp":1780050509772,"version":"3.53.1"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,2,22]],"date-time":"2017-02-22T00:00:00Z","timestamp":1487721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010766","name":"Schweizerischen Neurologischen Gesellschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010766","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004362","name":"Schweizerische Herzstiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004362","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006447","name":"Universit\u00e4t Z\u00fcrich","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006447","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Evidence for effective treatment options for orthostatic hypotension (<jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content>) in Parkinson's disease (<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>) is scarce. Elevation of cholinergic tone with pyridostigmine bromide has been reported as a way to improve blood pressure (bp) regulation in neurogenic hypotension without causing supine hypertension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a double\u2010centre, double\u2010blind, randomized, active\u2010control, crossover, phase <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> non\u2010inferiority trial of pyridostigmine bromide for <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> (clinicaltrials.gov <jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>01993680). Patients with confirmed <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> were randomized to 14 days 3 \u00d7 60 mg\/day pyridostigmine bromide or 1 \u00d7 0.2 mg\/day fludrocortisone before crossover. Outcome was measured by peripheral and central bp monitoring during the Schellong manoeuvre and questionnaires.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen participants were enrolled between April 2013 and April 2015 with nine participants completing each trial arm. Repeated measures comparison showed a significant 37% improvement with fludrocortisone for the primary outcome diastolic bp drop on orthostatic challenge (baseline 22.9 \u00b1 13.6 vs. pyridostigmine bromide 22.1 \u00b1 17.0 vs. fludrocortisone 14.0 \u00b1 12.6 mmHg; <jats:italic>P<\/jats:italic> = 0.04), whilst pyridostigmine bromide had no effect. Fludrocortisone caused an 11% peripheral systolic supine bp rise (baseline 128.4 \u00b1 12.8 vs. pyridostigmine bromide 130.4 \u00b1 18.3 vs. fludrocortisone 143.2 \u00b1 10.1 mmHg; <jats:italic>P<\/jats:italic> = 0.01) but no central mean arterial supine bp rise (baseline 107.2 \u00b1 7.8 vs. pyridostigmine bromide 97.0 \u00b1 12.0 vs. fludrocortisone 107.3 \u00b1 6.3 mmHg; <jats:italic>P<\/jats:italic> = 0.047). Subjective <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> severity, motor score and quality of life remained unchanged by both study interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pyridostigmine bromide is inferior to fludrocortisone in the treatment of <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>. This trial provides first objective evidence of the efficacy of 0.2 mg\/day fludrocortisone for <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>, causing minor peripheral but no central supine hypertension. In addition to peripheral bp, future trials should include central bp measurements, known to correlate more closely with cardiovascular risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13260","type":"journal-article","created":{"date-parts":[[2017,2,22]],"date-time":"2017-02-22T05:46:48Z","timestamp":1487742408000},"page":"545-551","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Pyridostigmine bromide versus fludrocortisone in the treatment of orthostatic hypotension in Parkinson's disease \u2013 a randomized controlled trial"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4129-5808","authenticated-orcid":false,"given":"S. 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