Normalization of Blood Pressure in a Patient With Severe Orthostatic Hypotension and Supine Hypertension Using Clonidine

To the Editor: A 78-year-old woman presented to us with a 4-year history of recurrent dizzy spells, which had increased in frequency over past 12-months. Past medical history included hypertension and glaucoma. Current medications were oral perindopril (an ACE inhibitor), aspirin, and 3 eye drops—brimonidine (a α2-adrenergic agonist), betaxolol (a topical β1-adrenergic blocking agent), and latanoprost (a selective prostanoid F2α-receptor agonist)—for glaucoma.Cardiovascular examination revealed an aortic ejection systolic murmur; supine blood pressure was 180/100 mm Hg. There was no clinical evidence of autonomic dysfunction, parkinsonian features, or gross neurological abnormalities.She had 4 presyncopal episodes over 5 days, with no arrhythmia on telemetry. She had mild aortic stenosis (peak and mean gradients of 19 and 11 mm Hg, respectively) and normal left ventricular function by echocardiography. …