Prostaglandin suppression: inability to correct severe idiopathic orthostatic hypotension.

A 70-year-old man with classic severe idiopathic orthostatic hypotension received three different indomethacin dose regimens. Baseline urinary prostaglandin concentrations were modestly elevated. Although indomethacin greatly lowered prostaglandin production, no sustained improvement in blood pressure or symptoms occurred. It is proposed that the interindividual variations in vascular reactivity and circulating prostaglandin levels may account for the beneficial responses to indomethacin of some patients and the modest responses of others.