Low-blood pressure phenotype underpins the tendency to reflex syncope

Michele Brignole; Giulia Rivasi; Richard Sutton; Rose Anne Kenny; Carlos A Morillo; Robert Sheldon; Satish R Raj; Andrea Ungar; Raffaello Furlan; Gert van Dijk; Mohamed Hamdan; Viktor Hamrefors; Gunnar Engström; Chloe Park; Davide Soranna; Antonella Zambon; Gianfranco Parati; Artur Fedorowski

doi:10.1097/HJH.0000000000002800

Low-blood pressure phenotype underpins the tendency to reflex syncope

Michele Brignole, Giulia Rivasi, Richard Sutton, Rose Anne Kenny, Carlos A Morillo, Robert Sheldon, Satish R Raj, Andrea Ungar, Raffaello Furlan, Gert van Dijk, Mohamed Hamdan, Viktor Hamrefors, Gunnar Engström, Chloe Park, Davide Soranna, Antonella Zambon, Gianfranco Parati, Artur Fedorowski

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex.

METHODS: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncope patients (6516 observations), subdivided by age decades and sex.

RESULTS: Overall, in male individuals with reflex syncope, SBP (-3.4 mmHg) and PP (-9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (-6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life.

CONCLUSION: The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not.

VIDEO ABSTRACT: http://links.lww.com/HJH/B580.

Original language	English
Pages (from-to)	1319-1325
Number of pages	7
Journal	Journal of Hypertension
Volume	39
Issue number	7
Early online date	2021 Feb 4
DOIs	https://doi.org/10.1097/HJH.0000000000002800
Publication status	Published - 2021 Jul 1

Subject classification (UKÄ)

Cardiology and Cardiovascular Disease

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10.1097/HJH.0000000000002800Licence: CC BY-NC-ND

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Brignole, M., Rivasi, G., Sutton, R., Kenny, R. A., Morillo, C. A., Sheldon, R., Raj, S. R., Ungar, A., Furlan, R., van Dijk, G., Hamdan, M., Hamrefors, V., Engström, G., Park, C., Soranna, D., Zambon, A., Parati, G., & Fedorowski, A. (2021). Low-blood pressure phenotype underpins the tendency to reflex syncope. Journal of Hypertension, 39(7), 1319-1325. https://doi.org/10.1097/HJH.0000000000002800

@article{950a4a51c60f49c889f19db9ead1bed6,

title = "Low-blood pressure phenotype underpins the tendency to reflex syncope",

abstract = "BACKGROUND: We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex.METHODS: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncope patients (6516 observations), subdivided by age decades and sex.RESULTS: Overall, in male individuals with reflex syncope, SBP (-3.4 mmHg) and PP (-9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (-6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life.CONCLUSION: The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not.VIDEO ABSTRACT: http://links.lww.com/HJH/B580.",

author = "Michele Brignole and Giulia Rivasi and Richard Sutton and Kenny, \{Rose Anne\} and Morillo, \{Carlos A\} and Robert Sheldon and Raj, \{Satish R\} and Andrea Ungar and Raffaello Furlan and \{van Dijk\}, Gert and Mohamed Hamdan and Viktor Hamrefors and Gunnar Engstr{\"o}m and Chloe Park and Davide Soranna and Antonella Zambon and Gianfranco Parati and Artur Fedorowski",

year = "2021",

month = jul,

day = "1",

doi = "10.1097/HJH.0000000000002800",

language = "English",

volume = "39",

pages = "1319--1325",

journal = "Journal of Hypertension",

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publisher = "Lippincott Williams \& Wilkins",

number = "7",

}

Brignole, M, Rivasi, G, Sutton, R, Kenny, RA, Morillo, CA, Sheldon, R, Raj, SR, Ungar, A, Furlan, R, van Dijk, G, Hamdan, M, Hamrefors, V , Engström, G, Park, C, Soranna, D, Zambon, A, Parati, G & Fedorowski, A 2021, 'Low-blood pressure phenotype underpins the tendency to reflex syncope', Journal of Hypertension, vol. 39, no. 7, pp. 1319-1325. https://doi.org/10.1097/HJH.0000000000002800

TY - JOUR

T1 - Low-blood pressure phenotype underpins the tendency to reflex syncope

AU - Brignole, Michele

AU - Rivasi, Giulia

AU - Sutton, Richard

AU - Kenny, Rose Anne

AU - Morillo, Carlos A

AU - Sheldon, Robert

AU - Raj, Satish R

AU - Ungar, Andrea

AU - Furlan, Raffaello

AU - van Dijk, Gert

AU - Hamdan, Mohamed

AU - Hamrefors, Viktor

AU - Engström, Gunnar

AU - Park, Chloe

AU - Soranna, Davide

AU - Zambon, Antonella

AU - Parati, Gianfranco

AU - Fedorowski, Artur

PY - 2021/7/1

Y1 - 2021/7/1

N2 - BACKGROUND: We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex.METHODS: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncope patients (6516 observations), subdivided by age decades and sex.RESULTS: Overall, in male individuals with reflex syncope, SBP (-3.4 mmHg) and PP (-9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (-6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life.CONCLUSION: The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not.VIDEO ABSTRACT: http://links.lww.com/HJH/B580.

AB - BACKGROUND: We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex.METHODS: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncope patients (6516 observations), subdivided by age decades and sex.RESULTS: Overall, in male individuals with reflex syncope, SBP (-3.4 mmHg) and PP (-9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (-6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life.CONCLUSION: The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not.VIDEO ABSTRACT: http://links.lww.com/HJH/B580.

UR - https://pubmed.ncbi.nlm.nih.gov/33560050/

UR - https://www.scopus.com/pages/publications/85105842638

U2 - 10.1097/HJH.0000000000002800

DO - 10.1097/HJH.0000000000002800

M3 - Article

C2 - 33560050

SN - 1473-5598

VL - 39

SP - 1319

EP - 1325

JO - Journal of Hypertension

JF - Journal of Hypertension

IS - 7

ER -

Low-blood pressure phenotype underpins the tendency to reflex syncope

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