AMBULATORY BLOOD PRESSURE MONITORING: A NEW DIAGNOSTIC APPROACH FOR DETECTION OF HYPOTENSION IN REFLEX SYNCOPE (SYNABPM 1 STUDY)

Giulia Rivasi, Antonella Groppelli, Michele Brignole, Davide Soranna, Antonella Zambon, Grzegorz Bilo, Martino Pengo, Bashaaer Sharad, Viktor Hamrefors, Martina Rafanelli, Giuseppe Dario Testa, Ciara Rice, Rose Anne Kenny, Richard Sutton, Andrea Ungar, Artur Fedorowski, Gianfranco Parati

Research output: Contribution to journalPublished meeting abstractpeer-review

Abstract

OBJECTIVE: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM. DESIGN AND METHOD: We conducted a retrospective analysis comparing ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (<110, 100, 90, 80 mmHg) were assessed. Hypotensive susceptibility was defined likely or possible for cut-offs achieving the highest sensitivity among those with specificity > 90% and 80-90%, respectively. Findings were validated in an independent sample. RESULTS: In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop < 90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR] = 4.6, p = 0.001). Two or more-daytime drops < 100 mmHg achieved 84% specificity and 40% sensitivity (OR = 3.5, p = 0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop < 90 mmHg provided 94% specificity and 29% sensitivity (OR = 6.2, p < 0.001), while two or more daytime SBP drops < 100 mmHg achieved 83% specificity and 35% sensitivity (OR = 3.5, p < 0.001). CONCLUSIONS: SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.

Original languageEnglish
Pages (from-to)e10
JournalJournal of Hypertension
Volume40
Issue numberSuppl 1
DOIs
Publication statusPublished - 2022

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

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