TY - JOUR
T1 - Interventions aimed to increase average 24-hour systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance
AU - Groppelli, Antonella
AU - Rivasi, Giulia
AU - Fedorowski, Artur
AU - de Lange, Frederik
AU - Russo, Vincenzo
AU - Maggi, Roberto
AU - Capacci, Marco
AU - Nawaz, Sara
AU - Comune, Angelo
AU - Bianchi, Lorenzo
AU - Zambon, Antonella
AU - Soranna, Davide
AU - Ungar, Andrea
AU - Parati, Gianfranco
AU - Brignole, Michele
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2024
Y1 - 2024
N2 - BACKGROUND AND AIMS: Systolic blood pressure (SBP) drops recorded by 24-hour ambulatory blood pressure (BP) monitoring (ABPM) identify patients with susceptibility to reflex syncope and orthostatic intolerance. We tested the hypothesis that treatments aimed to increase BP (reassurance, education & life-style measures plus pharmacological strategies) can reduce SBP drops.METHODS: Multicentre, observational proof-of-concept study performed in patients with reflex syncope and/or orthostatic intolerance and with SBP drops on a screening ABPM.RESULTS: Among 144 eligible patients, 111 underwent a second ABPM on average 2.5 months after start of treatment. Overall, mean 24-hour SBP increased from 114.1 ± 12.1 mmHg to 121.4 ± 14.5 mmHg (p < 0.0001). The number of SBP drops <90 mmHg and <100 mmHg decreased by 61%, 46% during daytime and by 48% and 37% during 24-hour period, respectively (p < 0.0001 for all). The dose-response relationship between difference in 24-hour average SBP increase and reduction in number of SBP drops reached a plateau around approximately 15 mmHg increase of 24-hour SBP. The reduction in SBP drop rate was consistent and significant in patients who underwent deprescription of hypotensive medications (n = 44) and in patients who received BP-rising drugs (n = 67).CONCLUSION: In patients with reflex syncope and/or orthostatic intolerance, an increase in average 24-hour SBP, regardless of the implemented strategy, significantly reduced the number of SBP drops and symptom burden. A 13 mmHg increase in 24-hour SBP appears to represent the optimal goal for aborting the maximal number of SBP drops, representing a possible target for future interventions.CLINCALTRIALS.GOV IDENTIFIER: NCT05729724.
AB - BACKGROUND AND AIMS: Systolic blood pressure (SBP) drops recorded by 24-hour ambulatory blood pressure (BP) monitoring (ABPM) identify patients with susceptibility to reflex syncope and orthostatic intolerance. We tested the hypothesis that treatments aimed to increase BP (reassurance, education & life-style measures plus pharmacological strategies) can reduce SBP drops.METHODS: Multicentre, observational proof-of-concept study performed in patients with reflex syncope and/or orthostatic intolerance and with SBP drops on a screening ABPM.RESULTS: Among 144 eligible patients, 111 underwent a second ABPM on average 2.5 months after start of treatment. Overall, mean 24-hour SBP increased from 114.1 ± 12.1 mmHg to 121.4 ± 14.5 mmHg (p < 0.0001). The number of SBP drops <90 mmHg and <100 mmHg decreased by 61%, 46% during daytime and by 48% and 37% during 24-hour period, respectively (p < 0.0001 for all). The dose-response relationship between difference in 24-hour average SBP increase and reduction in number of SBP drops reached a plateau around approximately 15 mmHg increase of 24-hour SBP. The reduction in SBP drop rate was consistent and significant in patients who underwent deprescription of hypotensive medications (n = 44) and in patients who received BP-rising drugs (n = 67).CONCLUSION: In patients with reflex syncope and/or orthostatic intolerance, an increase in average 24-hour SBP, regardless of the implemented strategy, significantly reduced the number of SBP drops and symptom burden. A 13 mmHg increase in 24-hour SBP appears to represent the optimal goal for aborting the maximal number of SBP drops, representing a possible target for future interventions.CLINCALTRIALS.GOV IDENTIFIER: NCT05729724.
U2 - 10.1093/europace/euae026
DO - 10.1093/europace/euae026
M3 - Article
C2 - 38262617
SN - 1532-2092
VL - 26
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
IS - 2
ER -