Association between hypotension during 24 h ambulatory blood pressure monitoring and reflex syncope: the SynABPM 1 study . (29th June 2022)

• Record Type: Journal Article
• Authors: Rivasi, Giulia; Groppelli, Antonella; Brignole, Michele; Soranna, Davide; Zambon, Antonella; Bilo, Grzegorz; Pengo, Martino; Sharad, Bashaaer; Hamrefors, Viktor; Rafanelli, Martina; Testa, Giuseppe Dario; Rice, Ciara; Kenny, Rose Anne; Sutton, Richard; Ungar, Andrea; Fedorowski, Artur; Parati, Gianfranco
• Is Part Of: European heart journal. Volume 43:Number 38(2022)
• Page Start: 3765
• Page End: 3776
• Publication Date: 2022-06-29
• Subjects: Hypotension -- Low blood pressure -- Blood pressure cut-off values -- Hypotensive episode -- Ambulatory blood pressure; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac347
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. The study hypothesis was that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM. Methods and results: ABPM data from reflex syncope patients and controls, matched by average 24 h SBP, age, sex, and hypertension were compared. Patients with constitutional hypotension, orthostatic hypotension, and predominant cardioinhibition during carotid sinus massage or prolonged electrocardiogram monitoring or competing causes of syncope were excluded. Daytime and nighttime SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample. In the derivation sample, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drops <90 mmHg achieved 91% specificity and 32% sensitivity [odds ratio (OR) 4.6, P < 0.001]. Two or more daytime drops <100 mmHg achieved 84% specificity and 40% sensitivity (OR 3.5, P = 0.001). Results were confirmed in the validation sample of 164 syncope patients and 164 controls: one or more daytime SBP drops <90 mmHg achieved 94% specificity and 29% sensitivity (OR 6.2, P < 0.001), while two or more daytime SBP drops <100 mmHg achieved 83% specificity and 35% sensitivity (OR 2.6, P < 0.001) Conclusion: SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope. Structured Graphical Abstract: Structured Graphical Abstract ABPM; ambulatory blood pressure monitoring; SBP, systolic blood pressure; HR, heart rate; DBP, diastolic blood pressure; PP, pulse pressure.