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AMBULATORY BLOOD PRESSURE MONITORING : A NEW DIAGNOSTIC APPROACH FOR DETECTION OF HYPOTENSION IN REFLEX SYNCOPE (SYNABPM 1 STUDY)

Rivasi, Giulia ; Groppelli, Antonella ; Brignole, Michele ; Soranna, Davide ; Zambon, Antonella ; Bilo, Grzegorz ; Pengo, Martino ; Sharad, Bashaaer ; Hamrefors, Viktor LU orcid and Rafanelli, Martina , et al. (2022) In Journal of Hypertension 40(Suppl 1). p.10-10
Abstract

OBJECTIVE: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM. DESIGN AND METHOD: We conducted a retrospective analysis comparing ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (<110, 100, 90, 80 mmHg) were assessed. Hypotensive susceptibility was defined likely or possible for cut-offs achieving the highest... (More)

OBJECTIVE: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM. DESIGN AND METHOD: We conducted a retrospective analysis comparing ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (<110, 100, 90, 80 mmHg) were assessed. Hypotensive susceptibility was defined likely or possible for cut-offs achieving the highest sensitivity among those with specificity > 90% and 80-90%, respectively. Findings were validated in an independent sample. RESULTS: In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop < 90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR] = 4.6, p = 0.001). Two or more-daytime drops < 100 mmHg achieved 84% specificity and 40% sensitivity (OR = 3.5, p = 0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop < 90 mmHg provided 94% specificity and 29% sensitivity (OR = 6.2, p < 0.001), while two or more daytime SBP drops < 100 mmHg achieved 83% specificity and 35% sensitivity (OR = 3.5, p < 0.001). CONCLUSIONS: SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Hypertension
volume
40
issue
Suppl 1
pages
10 - 10
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85136902632
  • pmid:36027509
ISSN
1473-5598
DOI
10.1097/01.hjh.0000835388.77387.e5
language
English
LU publication?
yes
additional info
Publisher Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
id
e09d24ba-d422-451c-8e04-8afdeef179e6
date added to LUP
2022-09-09 22:35:04
date last changed
2023-05-11 09:53:46
@misc{e09d24ba-d422-451c-8e04-8afdeef179e6,
  abstract     = {{<p>OBJECTIVE: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM. DESIGN AND METHOD: We conducted a retrospective analysis comparing ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (&lt;110, 100, 90, 80 mmHg) were assessed. Hypotensive susceptibility was defined likely or possible for cut-offs achieving the highest sensitivity among those with specificity &gt; 90% and 80-90%, respectively. Findings were validated in an independent sample. RESULTS: In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop &lt; 90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR] = 4.6, p = 0.001). Two or more-daytime drops &lt; 100 mmHg achieved 84% specificity and 40% sensitivity (OR = 3.5, p = 0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop &lt; 90 mmHg provided 94% specificity and 29% sensitivity (OR = 6.2, p &lt; 0.001), while two or more daytime SBP drops &lt; 100 mmHg achieved 83% specificity and 35% sensitivity (OR = 3.5, p &lt; 0.001). CONCLUSIONS: SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.</p>}},
  author       = {{Rivasi, Giulia and Groppelli, Antonella and Brignole, Michele and Soranna, Davide and Zambon, Antonella and Bilo, Grzegorz and Pengo, Martino and Sharad, Bashaaer and Hamrefors, Viktor and Rafanelli, Martina and Testa, Giuseppe Dario and Rice, Ciara and Kenny, Rose Anne and Sutton, Richard and Ungar, Andrea and Fedorowski, Artur and Parati, Gianfranco}},
  issn         = {{1473-5598}},
  language     = {{eng}},
  note         = {{Conference Abstract}},
  number       = {{Suppl 1}},
  pages        = {{10--10}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Journal of Hypertension}},
  title        = {{AMBULATORY BLOOD PRESSURE MONITORING : A NEW DIAGNOSTIC APPROACH FOR DETECTION OF HYPOTENSION IN REFLEX SYNCOPE (SYNABPM 1 STUDY)}},
  url          = {{http://dx.doi.org/10.1097/01.hjh.0000835388.77387.e5}},
  doi          = {{10.1097/01.hjh.0000835388.77387.e5}},
  volume       = {{40}},
  year         = {{2022}},
}