Arrhythmias & electrophysiology
Efficacy of fludrocortisone for symptom relief in patients with autonomic syncope and hypotensive phenotype
Authors' conclusion
Fludrocortisone therapy was associated with reduced hypotension and the burden of symptoms both in younger and in older patients. Side effects lead to discontinuation of therapy in 17% of cases.
Study context
- Population
- Patients with autonomic syncope and hypotensive phenotypeCohort treated with fludrocortisone (median age 38 [IQR 21–57]) years, 83% females), a total of 83 patients were analysed · Younger (23 ± 6 yrs), analysed 42 · Older (56 ± 12 yrs), analysed 41
- Participants
- 94 patients
- Comparison
- Before therapy vs during follow-up on fludrocortisone therapy; Ambulatory blood pressure monitoring (ABPM) 1 (before treatment start) vs ABPM 2 (after drug optimization)
- Fludrocortisone therapyn = 94
- Primary endpoint
- Reduction of the syncope burden and presyncopal symptoms based on validated semi structured questionnaires
- Follow-up
- Median 12.9 months
Primary result
As reported in the abstract
Reduction in annual syncope burden
50.2%
P = 0.0001
By group
- Subjective symptom improvement reported by
- 85.6% of patients
- The frequency of syncope/presyncope decreased significantly
- P = 0.009
Secondary outcomes
| Outcome | ABPM 1 | ABPM 2 | Decrease in number of daytime SBP drops | P value |
|---|---|---|---|---|
| Average 24-hour systolic blood pressure (SBP)Increased from ABPM 1 to ABPM 2 | 106.3 ± 8.2 mmHg | 112.3 ± 9.3 | P = 0.0001 | |
| Secondary endpoint: hypotensive episodes on ABPM (number of daytime SBP drops)SBP drops <90 mmHg | 61% | P < 0.001 for both | ||
| Secondary endpoint: hypotensive episodes on ABPM (number of daytime SBP drops)SBP drops <100 mmHg | 45% | P < 0.001 for both |
Outcome by age (subgroup)
- The outcome was similar in 42 younger (23 ± 6 yrs) and in 41 older (56 ± 12 yrs) patients
Safety
- Patients who stopped therapy due to side effects
- 16 patients
- Occurring during optimization
- #11
- Occurring during follow-up
- #5
Original publication
Efficacy of fludrocortisone for symptom relief in patients with autonomic syncope and hypotensive phenotype. Europace. Published 3 November 2026. doi:10.
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