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Stop vasodepressor drugs in reflex syncope: a randomised controlled trial.

Diana Solari1, Francesca Tesi2, Matthias Unterhuber3

  • 1Department of Cardiology, Arrhythmologic Center, Ospedali del Tigullio, Lavagna, Italy.

Heart (British Cardiac Society)
|September 25, 2016
PubMed
Summary

Reducing vasoactive therapy in elderly patients with reflex vasodepressor syncope significantly lowers recurrence of syncope and presyncope. This approach is safe and does not increase cardiovascular or neurological event risks.

Keywords:
CARDIAC PROCEDURES AND THERAPY

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Area of Science:

  • Cardiology
  • Geriatrics
  • Neurology

Background:

  • Elderly patients with reflex vasodepressor syncope often use hypotensive drugs.
  • The contribution of these medications to syncope episodes is not well-established.

Purpose of the Study:

  • To investigate if reducing or stopping vasoactive therapy decreases syncope and presyncope recurrence in elderly patients.
  • To assess the safety of this intervention regarding cardiovascular and neurological events.

Main Methods:

  • A randomized, parallel, prospective trial involving 58 elderly patients with vasodepressor reflex syncope.
  • Participants were randomized to either stop/reduce vasoactive therapy or continue it.
  • The primary endpoint was the recurrence of syncope, presyncope, or adverse cardiovascular/neurological events.

Main Results:

  • After one month, systolic blood pressure was higher in the 'stop/reduce' group.
  • Over a mean follow-up of 13 months, the primary endpoint occurred in 23% of the 'stop/reduce' group versus 54% in the 'continue' group (HR 0.37, p=0.02).
  • Fewer syncope and presyncope recurrences were observed in the group that stopped or reduced medication.

Conclusions:

  • Discontinuing or reducing vasoactive therapy is effective in lowering the recurrence of syncope and presyncope in elderly patients.
  • This strategy appears safe, without a significant increase in adverse cardiovascular or neurological events.