CoChat
Sign Up
Cited by 28Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlCerebrovascular and Carotid Artery Diseases

Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity

Brignole, Michele, Menozzi, Carlo, Gaggioli, Germano, Musso, Giacomo, Foglia-Manzillo, Giovanni, Mascioli, Giosuè, Fradella, Giuseppe, Bottoni, Nicola +1 more·1998·American Heart Journal
DOI 10.1053/hj.1998.v136.89911
Open this paper in CoChat — free account

Abstract

Background In patients affected by carotid sinus hypersensitivity, long-term vasodilator therapy might increase the risk of syncopal episodes by reducing systolic blood pressure and venous return to the heart.Methods and results Thirty-two patients (mean age 73 +/- 9 years; 20 men) who met all the following criteria were included: (1) one or more episodes of syncope occurring during long-term (>6 months) treatment with angiotensin-converting enzyme inhibitors, long-acting nitrates, calcium antagonists, or a combination of these; (2) a positive response to carotid sinus massage, defined as the reproduction of spontaneous syncope in the presence of ventricular asystole > or =3 seconds or a fall in systolic blood pressure > or =50 mm Hg; (3) negative workup for other causes of syncope. The patients were randomly assigned to continue or to discontinue use of vasodilators; carotid sinus massage was repeated 2 weeks after randomization. By the end of the study period, the baseline values of systolic blood pressure were significantly different between the 2 groups of patients both in supine (P=.01) and upright (P=.03) positions. Syncope had been induced by carotid sinus massage in 81% of patients in the "on-vasodilator" group and in 62% of patients in the "off-vasodilator" group (P=.21). The cardioinhibitory reflex was of similar magnitude in the 2 groups, being found in 50% of the patients in each group, with a maximum ventricular pause of 7.1 +/- 2.7 and 6.7 +/- 1.8 seconds, respectively. The percentage decrease of blood pressure did not differ between the 2 groups, even if, in absolute values, the baseline difference of blood pressure roughly persisted for the duration of the test. In consequence of that, the rise of blood pressure to similar values was delayed approximately 30 seconds in the "on-vasodilator" group and took more than 2 minutes to return to baseline values.Conclusions In patients affected by carotid sinus hypersensitivity, chronic vasodilator therapy does not have a direct effect on carotid sinus reflexivity, although the delayed recovery of pretest blood pressure values could indirectly potentiate the severity of the clinical manifestations of the syndrome. The persistence of hypotension for a longer time after the end of the massage suggests that vasodilators cause an impairment of compensatory mechanisms.

Integrity signals

Registry

Crossref · 10.1053/hj.1998.v136.89911

Cites

13 of 13 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a short-term randomized trial of 32 patients with CSS, withdrawal of vasodilator therapy reduced the magnitude of the vasodepressor reflex induced by CSM.

    “In a short-term randomized trial 262 conducted in 32 patients affected by CSS, withdrawal of vasodilator therapy reduced the magnitude of the vasodepressor reflex induced by CSM.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [262]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Brignole, M., Menozzi, C., Gaggioli, G., Musso, G., Foglia-Manzillo, G., Mascioli, G., Fradella, G., Bottoni, N., & Mureddu, R.
ORCID
Venue
American Heart Journal
Publisher
Elsevier BV
Published
1998-08
Volume
136
Issue
2
Pages
264-268
ISSN
0002-8703 (ISSN-L)
DOI
10.1053/hj.1998.v136.89911
OpenAlex
W2166101855
Cited by
28
References
13
Citations by year
2026: 1 · 2024: 3 · 2022: 1 · 2019: 3 · 2018: 4 · 2016: 1 · 2014: 1 · 2013: 3
FWCI
0.74
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
Keywords
carotid sinus hypersensitivity, vasodilator therapy, syncope, carotid sinus reflex, ACE inhibitors, long-acting nitrates, calcium channel blockers, blood pressure recovery, hypotension, carotid sinus massage, ventricular asystole, elderly patients, drug discontinuation, venous return
MeSH terms
Aged, Aged, 80 and over, Blood Pressure, Carotid Sinus, Female, Heart Arrest, Homeostasis, Humans, Long-Term Care, Male, Massage, Middle Aged, Pressoreceptors, Reflex, Abnormal, Risk Factors, Syncope, Syndrome, Vasodilator Agents, Venous Pressure

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review