HypertensionCohort study
Interventions aimed to increase average 24-h systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance
- Observational proof-of-concept study
- multicentre
- before-after (second ABPM after treatment start)
Authors' conclusion
In patients with reflex syncope and/or orthostatic intolerance, an increase in average 24-h SBP, regardless of the implemented strategy, significantly reduced the number of SBP drops and symptom burden.
Study context
- Population
- Patients with reflex syncope and/or orthostatic intolerance and systolic blood pressure (SBP) drops on a screening 24-h ABPM111 with second ABPM
- Participants
- 144 patients
- Exposure
- Treatments aimed to increase blood pressure (BP), before vs after
- Outcome
- Number of SBP drops on 24-h ABPM
- Follow-up
- Second ABPM on average 2.5 months after start of treatment
Main finding
As reported in the abstract
SBP drops and mean 24-h SBP, before vs after treatment · on average 2.5 months after start of treatment
- Mean 24-h SBP increased from 114.1 ± 12.1 to 121.4 ± 14.5 mmHg
- P < 0.0001
- Daytime SBP drops <90 mmHg decreased by
- 61%
- Daytime SBP drops <100 mmHg decreased by
- 46%
- 24-h SBP drops <90 mmHg decreased by
- 48%
- 24-h SBP drops <100 mmHg decreased by
- 37%
Observational data: associations, not effects.
Further findings
Dose-response: 24-h SBP increase vs reduction in SBP drops
- Reduction in SBP drops reached a plateau around ∼15 mmHg increase of 24-h SBP
SBP drop rate, by strategy (subgroups)
- Consistent and significant reduction with deprescription of hypotensive medications (n = 44)
- Consistent and significant reduction with BP-rising drugs (n = 67)
Original publication
Interventions aimed to increase average 24-h systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance. Europace. Published 23 January 2024. doi:10.1093/europace/euae026
Summarised from the published abstract; every number is checked against it