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Cited by 55Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlCardiovascular Health and Disease Prevention

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Low-blood pressure phenotype underpins the tendency to reflex syncope

Open access
Brignole, Michele, Rivasi, Giulia, Sutton, Richard, Kenny, Rose Anne, Morillo, Carlos A., Sheldon, Robert, Raj, Satish R., Ungar, Andrea, Furlan, Raffaello, van Dijk, Gert, Hamdan, Mohamed, Hamrefors, Viktor, Engström, Gunnar, Park, Chloe, Soranna, Davide, Zambon, Antonella, Parati, Gianfranco, Fedorowski, Artur·2021·Journal of Hypertension
DOI 10.1097/hjh.0000000000002800PMC PMC8183486

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Abstract

Background: We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex. Methods: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncope patients (6516 observations), subdivided by age decades and sex. Results: Overall, in male individuals with reflex syncope, SBP (−3.4 mmHg) and PP (−9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (−6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life. Conclusion: The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not. Video abstract: http://links.lww.com/HJH/B580.

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Crossref · 10.1097/hjh.0000000000002800

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FIGURE 1 Different hemodynamic profiles of SBP, DBP, pulse pressure (PP), and heart rate in beats per minute (bpm) in male and female individuals with reflex syncope and in the general population. Data are shown over the different decades, throughout the lifespan.
FIGURE 1 Different hemodynamic profiles of SBP, DBP, pulse pressure (PP), and heart rate in beats per minute (bpm) in male and female individuals with reflex syncope and in the general population. Data are shown over the different decades, throughout the lifespan.CC BY-NC-ND · PubMed Central
FIGURE 2 Comparison between sex in patients with reflex syncope. The upper part shows the patterns of incremental SBP elevation from youth in male and female individuals. Data are shown over the different decades, throughout the lifespan. SBP increases progressively with age. Compared with men, women exhibit a slower increase until the age of 40 years and then a steeper increase that continues throughout the rest of life. SBP declines in men after the age of 60 years. A significant interaction of sex with age is present (P = 0.0001). The lower part of the figure shows the male/female ratio of reflex syncope per age decade. The relative rate of syncope in men and women is related to their SBP until the sixth decade. The slightly higher rate of women at ages at least 80 years is likely because of the higher census prevalence of womrn in those ages. Chi-square test for trends: P = 0.0001.
FIGURE 2 Comparison between sex in patients with reflex syncope. The upper part shows the patterns of incremental SBP elevation from youth in male and female individuals. Data are shown over the different decades, throughout the lifespan. SBP increases progressively with age. Compared with men, women exhibit a slower increase until the age of 40 years and then a steeper increase that continues throughout the rest of life. SBP declines in men after the age of 60 years. A significant interaction of sex with age is present (P = 0.0001). The lower part of the figure shows the male/female ratio of reflex syncope per age decade. The relative rate of syncope in men and women is related to their SBP until the sixth decade. The slightly higher rate of women at ages at least 80 years is likely because of the higher census prevalence of womrn in those ages. Chi-square test for trends: P = 0.0001.CC BY-NC-ND · PubMed Central
FIGURE 3 The haemodynamic cascade of orthostatic vasovagal syncope (see text for explanation). HR, heart rate; VV, vasovagal.
FIGURE 3 The haemodynamic cascade of orthostatic vasovagal syncope (see text for explanation). HR, heart rate; VV, vasovagal.CC BY-NC-ND · PubMed Central

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Citations

Cites

Research works printed but not linked: 21

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Metadata

Authors
Brignole, M., Rivasi, G., Sutton, R., Kenny, R. A., Morillo, C. A., Sheldon, R., Raj, S. R., Ungar, A., Furlan, R., van Dijk, G., Hamdan, M., Hamrefors, V., Engström, G., Park, C., Soranna, D., Zambon, A., Parati, G., & Fedorowski, A.
Affiliations
  • IRCCS Istituto Auxologico Italiano (IT)
  • Azienda Ospedaliero-Universitaria Careggi (IT)
  • Hammersmith Hospital (GB)
  • Trinity College Dublin (IE)
  • University of Calgary (CA)
  • Humanitas University (IT)
  • Leiden University Medical Center (NL)
  • University of Wisconsin–Madison (US)
  • Lund University (SE)
  • MRC Unit for Lifelong Health and Ageing (GB)
Corresponding author
  • Parati, Gianfranco
  • Fedorowski, Artur
ORCID
Venue
Journal of Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-02-04
Volume
39
Issue
7
Pages
1319-1325
ISSN
  • 0263-6352 (ISSN-L)
  • 1473-5598
DOI
10.1097/hjh.0000000000002800
PMC
PMC8183486
OpenAlex
W3126530869
Cited by
55
References
7
Citations by year
2026: 4 · 2025: 10 · 2024: 10 · 2023: 14 · 2022: 13 · 2021: 4
FWCI
9.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Hypertension (publishedVersion, cc-by-nc-nd)
  • medRxiv (acceptedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • BOA (University of Milano-Bicocca) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
Funders
  • Wellcome Trust (217065/Z/19/Z)
  • Medical Research Council (MC_PC_15018, MC_PC_19009)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
reflex syncope, vasovagal reflex, resting blood pressure, pulse pressure, heart rate, diastolic blood pressure, cardiovascular hemodynamics, sex differences, age differences, venous return, stroke volume
MeSH terms
Adult, Blood Pressure, Cross-Sectional Studies, Female, Humans, Male, Phenotype, Reflex, Syncope

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