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Targets for deprescribing in patients with hypertension and reflex syncope

Groppelli, Antonella ; Rivasi, Giulia ; Fedorowski, Artur LU orcid ; de Lange, Frederik ; Russo, Vincenzo ; Maggi, Roberto ; Capacci, Marco ; Nawaz, Sara ; Comune, Angelo and Ungar, Andrea , et al. (2024) In European Journal of Internal Medicine
Abstract

BACKGROUND: We aimed to identify the target of deprescribing, i.e. the 24-hour SBP increase needed to achieve the greatest reduction of SBP drops.

METHOD: Forty hypertensive patients (mean age 73.6 ± 9.3 years, 26 females) with reflex syncope and SBP drops on a screening ABPM were advised to withdraw or to reduce their therapy. The study objective was the reduction of SBP drops <90 mmHg and <100 mmHg on a second ABPM performed within 3 months.

RESULTS: Out of a total of 98 drugs taken during ABPM 1, 44 were withdrawn, 16 had a dose reduction and 38 remained unchanged at the time of ABPM 2. 24-hour SBP increased from 119.7 ± 10.1 mmHg to 129.4 ± 13.2 mmHg during ABPM2. Total disappearance of daytime SBP drops <100... (More)

BACKGROUND: We aimed to identify the target of deprescribing, i.e. the 24-hour SBP increase needed to achieve the greatest reduction of SBP drops.

METHOD: Forty hypertensive patients (mean age 73.6 ± 9.3 years, 26 females) with reflex syncope and SBP drops on a screening ABPM were advised to withdraw or to reduce their therapy. The study objective was the reduction of SBP drops <90 mmHg and <100 mmHg on a second ABPM performed within 3 months.

RESULTS: Out of a total of 98 drugs taken during ABPM 1, 44 were withdrawn, 16 had a dose reduction and 38 remained unchanged at the time of ABPM 2. 24-hour SBP increased from 119.7 ± 10.1 mmHg to 129.4 ± 13.2 mmHg during ABPM2. Total disappearance of daytime SBP drops <100 mmHg was achieved in 20 (50 %) patients who had 24-hour SBP of 134±13 mmHg and an increase from ABPM 1 of 12 (IQR 5-20) mmHg. Compared with the 20 patients who had persistence of drops, these patients had a greater reduction of the number of hypotensive drugs (67 % versus 19 %, p = 0.002) and a greater rate of withdrawals (62 % versus 29 %, p = 0.003).

CONCLUSION: In hypertensive patients with reflex syncope, an increase of 12 mmHg and an absolute value of 24-hour SBP of 134 mmHg appear to represent the optimal goals aimed to prevent SBP drops. Drugs withdrawal, rather than simply dose reduction, is mostly required to achieve the above target.

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publishing date
type
Contribution to journal
publication status
epub
subject
in
European Journal of Internal Medicine
publisher
Elsevier
external identifiers
  • scopus:85194073078
  • pmid:38789289
ISSN
1879-0828
DOI
10.1016/j.ejim.2024.05.014
language
English
LU publication?
no
additional info
Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
id
1f19193b-1aae-4412-bbf9-276814800a40
date added to LUP
2024-05-27 14:27:24
date last changed
2024-06-24 05:18:39
@article{1f19193b-1aae-4412-bbf9-276814800a40,
  abstract     = {{<p>BACKGROUND: We aimed to identify the target of deprescribing, i.e. the 24-hour SBP increase needed to achieve the greatest reduction of SBP drops.</p><p>METHOD: Forty hypertensive patients (mean age 73.6 ± 9.3 years, 26 females) with reflex syncope and SBP drops on a screening ABPM were advised to withdraw or to reduce their therapy. The study objective was the reduction of SBP drops &lt;90 mmHg and &lt;100 mmHg on a second ABPM performed within 3 months.</p><p>RESULTS: Out of a total of 98 drugs taken during ABPM 1, 44 were withdrawn, 16 had a dose reduction and 38 remained unchanged at the time of ABPM 2. 24-hour SBP increased from 119.7 ± 10.1 mmHg to 129.4 ± 13.2 mmHg during ABPM2. Total disappearance of daytime SBP drops &lt;100 mmHg was achieved in 20 (50 %) patients who had 24-hour SBP of 134±13 mmHg and an increase from ABPM 1 of 12 (IQR 5-20) mmHg. Compared with the 20 patients who had persistence of drops, these patients had a greater reduction of the number of hypotensive drugs (67 % versus 19 %, p = 0.002) and a greater rate of withdrawals (62 % versus 29 %, p = 0.003).</p><p>CONCLUSION: In hypertensive patients with reflex syncope, an increase of 12 mmHg and an absolute value of 24-hour SBP of 134 mmHg appear to represent the optimal goals aimed to prevent SBP drops. Drugs withdrawal, rather than simply dose reduction, is mostly required to achieve the above target.</p>}},
  author       = {{Groppelli, Antonella and Rivasi, Giulia and Fedorowski, Artur and de Lange, Frederik and Russo, Vincenzo and Maggi, Roberto and Capacci, Marco and Nawaz, Sara and Comune, Angelo and Ungar, Andrea and Parati, Gianfranco and Brignole, Michele}},
  issn         = {{1879-0828}},
  language     = {{eng}},
  month        = {{05}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Internal Medicine}},
  title        = {{Targets for deprescribing in patients with hypertension and reflex syncope}},
  url          = {{http://dx.doi.org/10.1016/j.ejim.2024.05.014}},
  doi          = {{10.1016/j.ejim.2024.05.014}},
  year         = {{2024}},
}