Deprescribing of blood pressure-lowering medications in patients with hypotensive syncope
(2026) In European Journal of Internal Medicine p.1-6- Abstract
AIM: To assess the efficacy of deprescribing blood pressure-lowering medications in hypertensive patients suffering from severe hypotensive syncope.
METHOD: Multicentre, prospective, pragmatic, non-randomized uncontrolled, study. Deprescribing (withdrawal or dose reduction of antihypertensive and psychoactive medications with blood pressure lowering effects) was guided by clinical experience and supported by two 24-hour ambulatory blood pressure monitoring (ABPM) assessments-one before (ABPM 1) and one after (ABPM 2) drug optimization. Primary endpoint was the reduction of the burden of syncope.
RESULTS: In a cohort of 92 patients (mean age 76.6 ± 12.1 years, 53% female), the total number of hypotensive medications decreased... (More)
AIM: To assess the efficacy of deprescribing blood pressure-lowering medications in hypertensive patients suffering from severe hypotensive syncope.
METHOD: Multicentre, prospective, pragmatic, non-randomized uncontrolled, study. Deprescribing (withdrawal or dose reduction of antihypertensive and psychoactive medications with blood pressure lowering effects) was guided by clinical experience and supported by two 24-hour ambulatory blood pressure monitoring (ABPM) assessments-one before (ABPM 1) and one after (ABPM 2) drug optimization. Primary endpoint was the reduction of the burden of syncope.
RESULTS: In a cohort of 92 patients (mean age 76.6 ± 12.1 years, 53% female), the total number of hypotensive medications decreased from 218 (2.4 ± 1.1 per patient) before deprescribing to 123 (1.3 ± 1.0 per patient) after the intervention. The 24-hour systolic blood pressure increased from 118.8 ± 10.8 mmHg at ABPM 1 to 127.5 ± 11.6 at ABPM 2 (p = 0.0001). The number of daytime SBP drops <90 mmHg and <100 mmHg decreased by 52%, (from 208 to 100) and 53% (from 601 to 280), respectively (p = 0.0001 for both). During the mean follow-up of 12.6 ± 3.8 months (range 2 to 21 months), 28 patients (30.4%) had syncopal recurrences. Excluding the index episode, patients experienced 111 episodes in the year before enrolment and 41 during the overall follow-up. The syncope burden dropped by 66%, from 0.08 (IQR 0-0.17) to 0 (IQR 0-0.07) episodes per month (p = 0.0001).
CONCLUSION: In patients with hypertension and hypotensive syncope deprescribing of blood pressure lowering medications reduced hypotensive episodes and syncopal recurrences. However, the findings preclude firm causal inferences.
(Less)
- author
- Russo, Vincenzo
; Parente, Erika
; Comune, Angelo
; Groppelli, Antonella
; Francisco-Pascual, Jaume
; Rivas-Gándara, Nuria
; Deharo, Jean-Claude
; Maille, Baptiste
; De Lange, Frederik J
; Boel, Thomas T
; Rivasi, Giulia
LU
; Laffi, Mattia
; Maggi, Roberto
; Kenny, Rose Anne
; Fedorowski, Artur
LU
; Parati, Gianfranco
and Brignole, Michele
(Less) - publishing date
- 2026-08-11
- type
- Contribution to journal
- publication status
- epub
- in
- European Journal of Internal Medicine
- article number
- 107119
- pages
- 1 - 6
- publisher
- Elsevier
- external identifiers
-
- scopus:105046887932
- pmid:42580907
- ISSN
- 1879-0828
- DOI
- 10.1016/j.ejim.2026.107119
- language
- English
- LU publication?
- no
- additional info
- Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.
- id
- 38c24e6a-a62b-4b67-b5a3-fd9175f0ffcf
- date added to LUP
- 2026-08-17 16:44:29
- date last changed
- 2026-09-01 04:55:35
@article{38c24e6a-a62b-4b67-b5a3-fd9175f0ffcf,
abstract = {{<p>AIM: To assess the efficacy of deprescribing blood pressure-lowering medications in hypertensive patients suffering from severe hypotensive syncope.</p><p>METHOD: Multicentre, prospective, pragmatic, non-randomized uncontrolled, study. Deprescribing (withdrawal or dose reduction of antihypertensive and psychoactive medications with blood pressure lowering effects) was guided by clinical experience and supported by two 24-hour ambulatory blood pressure monitoring (ABPM) assessments-one before (ABPM 1) and one after (ABPM 2) drug optimization. Primary endpoint was the reduction of the burden of syncope.</p><p>RESULTS: In a cohort of 92 patients (mean age 76.6 ± 12.1 years, 53% female), the total number of hypotensive medications decreased from 218 (2.4 ± 1.1 per patient) before deprescribing to 123 (1.3 ± 1.0 per patient) after the intervention. The 24-hour systolic blood pressure increased from 118.8 ± 10.8 mmHg at ABPM 1 to 127.5 ± 11.6 at ABPM 2 (p = 0.0001). The number of daytime SBP drops <90 mmHg and <100 mmHg decreased by 52%, (from 208 to 100) and 53% (from 601 to 280), respectively (p = 0.0001 for both). During the mean follow-up of 12.6 ± 3.8 months (range 2 to 21 months), 28 patients (30.4%) had syncopal recurrences. Excluding the index episode, patients experienced 111 episodes in the year before enrolment and 41 during the overall follow-up. The syncope burden dropped by 66%, from 0.08 (IQR 0-0.17) to 0 (IQR 0-0.07) episodes per month (p = 0.0001).</p><p>CONCLUSION: In patients with hypertension and hypotensive syncope deprescribing of blood pressure lowering medications reduced hypotensive episodes and syncopal recurrences. However, the findings preclude firm causal inferences.</p>}},
author = {{Russo, Vincenzo and Parente, Erika and Comune, Angelo and Groppelli, Antonella and Francisco-Pascual, Jaume and Rivas-Gándara, Nuria and Deharo, Jean-Claude and Maille, Baptiste and De Lange, Frederik J and Boel, Thomas T and Rivasi, Giulia and Laffi, Mattia and Maggi, Roberto and Kenny, Rose Anne and Fedorowski, Artur and Parati, Gianfranco and Brignole, Michele}},
issn = {{1879-0828}},
language = {{eng}},
month = {{08}},
pages = {{1--6}},
publisher = {{Elsevier}},
series = {{European Journal of Internal Medicine}},
title = {{Deprescribing of blood pressure-lowering medications in patients with hypotensive syncope}},
url = {{http://dx.doi.org/10.1016/j.ejim.2026.107119}},
doi = {{10.1016/j.ejim.2026.107119}},
year = {{2026}},
}