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Interventions aimed to increase average 24-hour systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance

Groppelli, Antonella ; Rivasi, Giulia ; Fedorowski, Artur LU orcid ; de Lange, Frederik ; Russo, Vincenzo ; Maggi, Roberto ; Capacci, Marco ; Nawaz, Sara ; Comune, Angelo and Bianchi, Lorenzo , et al. (2024) In 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
Abstract

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 ±... (More)

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.

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publication status
epub
subject
in
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
publisher
Oxford University Press
external identifiers
  • scopus:85184617853
  • pmid:38262617
ISSN
1532-2092
DOI
10.1093/europace/euae026
language
English
LU publication?
no
additional info
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
id
6dc679d0-9da9-4e4a-a122-c3be9459dbf1
date added to LUP
2024-01-29 12:13:05
date last changed
2024-04-23 16:01:51
@article{6dc679d0-9da9-4e4a-a122-c3be9459dbf1,
  abstract     = {{<p>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 &amp; life-style measures plus pharmacological strategies) can reduce SBP drops.</p><p>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.</p><p>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 &lt; 0.0001). The number of SBP drops &lt;90 mmHg and &lt;100 mmHg decreased by 61%, 46% during daytime and by 48% and 37% during 24-hour period, respectively (p &lt; 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).</p><p>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.</p><p>CLINCALTRIALS.GOV IDENTIFIER: NCT05729724.</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 Bianchi, Lorenzo and Zambon, Antonella and Soranna, Davide and Ungar, Andrea and Parati, Gianfranco and Brignole, Michele}},
  issn         = {{1532-2092}},
  language     = {{eng}},
  month        = {{01}},
  publisher    = {{Oxford University Press}},
  series       = {{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}},
  title        = {{Interventions aimed to increase average 24-hour systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance}},
  url          = {{http://dx.doi.org/10.1093/europace/euae026}},
  doi          = {{10.1093/europace/euae026}},
  year         = {{2024}},
}