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Stop vasodepressor drugs in reflex syncope: a randomised controlled trial
Abstract
OBJECTIVES: Most elderly patients affected by reflex vasodepressor syncope take one or more hypotensive drugs. The role of these drugs in causing syncope has not yet been established. We hypothesised that recurrence of syncope and presyncope can be reduced by discontinuing/reducing vasoactive therapy without increasing the risk of cardiovascular and neurological events. METHODS: This randomised, parallel, prospective, trial was conducted from January 2014 to March 2016 in four general hospitals. Of 328 initially screened participants, 58 patients (mean (SD) age 74±11 years) affected by vasodepressor reflex syncope, which was reproduced by tilt testing (n=54) or carotid sinus massage (n=4), were randomised to stop/reduce vasoactive therapy or to continue it. Primary end point was recurrence of syncope, presyncope or adverse events (defined as stroke, cerebral transient ischaemic attacks, worsening heart failure, myocardial infarction). RESULTS: Of 58 patients who were randomised, 55 completed the trial. After 1 month, systolic blood pressure was significantly higher in the 'stop/reduce' group than in the 'continue' group, in both supine (141±13 mm Hg vs 128±14 mm Hg; p=0.004) and standing (133±13 mm Hg vs 122±15 mm Hg; p=0.02) positions. During a mean follow-up of 13±7 months, the primary combined end point occurred in seven 'stop/reduce' patients (23%): three had syncope, three had presyncope and one had heart failure. Conversely, it occurred in 13 'continue' patients (54%): 10 had syncope, 2 had presyncope and 1 had cerebral transient ischaemic attack. The log-rank p value was 0.02 and the HR was 0.37 (95% CI 0.15 to 0.91). CONCLUSIONS: Recurrence of syncope and presyncope can be reduced by discontinuing/reducing vasoactive therapy in most elderly patients affected by reflex vasodepressor syncope. TRIAL REGISTRATION NUMBER: NCT01509534; EudraCT2013-004364-63; Results.
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In a small randomized trial of 58 patients with vasodepressor reflex syncope on hypotensive drugs, discontinuation or reduction of vasoactive therapy reduced the primary combined endpoint of syncope, presyncope, and adverse events from 50% to 19% (hazard ratio 0.37) compared with a control group over 9 months.
“In a small randomized trial 260 performed in 58 patients (mean age 74 ± 11 years) affected by vasodepressor reflex syncope diagnosed by tilt testing or CSM, who were taking on average 2.5 hypotensive drugs, discontinuation or reduction of the vasoactive therapy caused a reduction of the rate of the primary combined endpoint of syncope, presyncope, and adverse events from 50 to 19% (hazard ratio 0.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [260]
Discontinuation or reduction of hypotensive therapy reduces the risk of syncope and falls.
“Conversely, the discontinuation or reduction of hypotensive therapy reduces such risk. 260”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [260]
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2013 ESH/ESC Guidelines for the management of arterial hypertension
Authors Task Force Members, Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., Christiaens, T., Cífková, R., Backer, G. D., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht151 · Cited by 13,728
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
The SPRINT Research Group (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1511939 · Cited by 6,325
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
Self-citationCampbell, A. J., Robertson, M. C., Gardner, M. M., Norton, R. N., & Büchner, D. M. (1999) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1999.tb03843.x · Cited by 552
Bartoletti, A. (2000) · Europace · doi:10.1053/eupc.2000.0125 · Cited by 315
Bénétos, A., Labat, C., Rossignol, P., Fay, R., Rolland, Y., Valbusa, F., Salvi, P., Zamboni, M. M., Manckoundia, P., Hanon, O., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.8012 · Cited by 290
Mossello, E., Pieraccioli, M., Nesti, N., Bulgaresi, M., Lorenzi, C., Caleri, V., Tonon, E., Cavallini, M. C., Baroncini, C., Di Bari, M., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.8164 · Cited by 247
Self-citationPodoleanu, C., Maggi, R., Brignole, M., Croci, F., Incze, A., Solano, A., Puggioni, E., & Carasca, E. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.06.052 · Cited by 165
Self-citation2013 ESH/ESC GUIDELINES FOR THE MANAGEMENT OF ARTERIAL HYPERTENSION
Article, E. (2014) · Eurasian heart journal · doi:10.38109/2225-1685-2014-1-4-79 · Cited by 106
Bradley, J. G., & Davis, K. A. (2003) · PubMed · Cited by 87
Brignole, M., Ammirati, F., Arabia, F., Quartieri, F., Tomaino, M., Ungar, A., Lunati, M., Russo, V., Del Rosso, A., & Gaggioli, G. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv069 · Cited by 80
Self-citationCanney, M., O’Connell, M. D. L., Murphy, C. M., O’Leary, N., Little, M. A., O’Seaghdha, C. M., & Kenny, R. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0146156 · Cited by 73
Mussi, C., Ungar, A., Salvioli, G., Menozzi, C., Bartoletti, A., Giada, F., Lagi, A., Ponassi, I., Re, G., Furlan, R., et al. (2009) · The Journals of Gerontology Series A · doi:10.1093/gerona/glp028 · Cited by 70
Self-citationWithdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes
Van Der Velde, N., Van Den Meiracker, A. H., Pols, H. A. P., Stricker, B. H. C., & Van Der Cammen, T. J. M. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01137.x · Cited by 59
Solari, D., Maggi, R., Oddone, D., Solano, A., Croci, F., Donateo, P., & Brignole, M. (2014) · Europace · doi:10.1093/europace/eut283 · Cited by 52
Self-citationBlood pressure lowering therapy in older people: Does it really cause postural hypotension or falls?
Zia, A., Kamaruzzaman, S. B., & Tan, M. P. (2015) · Postgraduate Medicine · doi:10.1080/00325481.2015.996505 · Cited by 31
Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity
Brignole, M., Menozzi, C., Gaggioli, G., Musso, G., Foglia-Manzillo, G., Mascioli, G., Fradella, G., Bottoni, N., & Mureddu, R. (1998) · American Heart Journal · doi:10.1053/hj.1998.v136.89911 · Cited by 28
Kaufmann, H., & Biaggioni, I. (2004) · Neurology and Clinical Neuroscience · doi:10.1016/b978-0-323-03354-1.50032-8 · Cited by 15
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2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
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Metadata
- Authors
- Solari, D., Tesi, F., Unterhuber, M., Gaggioli, G., Ungar, A., Tomaino, M., & Brignole, M.
- Affiliations
- Presidio Ospedaliero (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Ospedale di Bolzano (IT)
- Ospedale Villa Scassi (IT)
- Corresponding author
- Brignole, Michele
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2016-09-23
- Volume
- 103
- Issue
- 6
- Pages
- 449-455
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2521185291
- Cited by
- 68
- References
- 18
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 9 · 2023: 4 · 2022: 9 · 2021: 13 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 4
- FWCI
- 5.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- reflex syncope, vasodepressor syncope, antihypertensive drugs, vasoactive therapy, drug discontinuation, syncope recurrence, presyncope, elderly patients, tilt table test, carotid sinus massage, systolic blood pressure, adverse events, stroke, heart failure, myocardial infarction, transient ischemic attack, antihypertensive therapy, antihypertensive withdrawal
- MeSH terms
- Aged, Aged, 80 and over, Blood Pressure, Cardiovascular System, Drug Administration Schedule, Female, Hospitals, General, Humans, Italy, Male, Middle Aged, Posture, Prospective Studies, Recurrence, Reflex, Vasoconstrictor Agents, Treatment Outcome, Tilt-Table Test, Syncope, Vasovagal
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