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Treatment of vasodepressor carotid sinus syndrome with midodrine: a randomized, controlled pilot study.
J Am Geriatr Soc. 2005 Jan; 53(1):114-8.JA

Abstract

OBJECTIVES

To evaluate the efficacy of treatment of the vasodepressor form of carotid sinus hypersensitivity (carotid sinus syndrome (CSS)) with midodrine.

DESIGN

A prospective, double-blind, randomized, controlled trial of crossover design.

SETTING

A dedicated outpatient facility with access to tilt-table, digital arterial photoplethysmography, and 24-hour ambulatory blood pressure (BP) monitoring equipment.

PARTICIPANTS

Ten older adults (4 male, 6 female, mean age 75, range 66-86 years) with a history of unexplained syncope who displayed an asymptomatic decrease in systolic BP (SBP) of more than 50 mmHg or a symptomatic decrease of more than 30 mmHg within 30 seconds of carotid sinus massage (CSM).

MEASUREMENTS

Symptom reproduction and BP and heart rate changes were evaluated after CSM in supine and semierect positions on the right and then left sides. These measurements were performed on the final day of placebo and active-treatment phases. Ambulatory 24-hour BP monitoring took place on the penultimate and final days of each treatment phase.

RESULTS

Eight patients were symptomatic after their initial CSM. The mean+/-standard deviation SBP decrease after initial CSM was 54+/-22 mmHg. Initial mean 24-hour ambulatory BP was 127/70+/-7/5 mmHg. Eight patients reported symptoms after CSM at the end of the placebo phase. The mean SBP decrease at the end of the placebo phase was 49+/-12 mmHg. The mean 24-hour ambulatory BP was 127/69+/-9/7 mmHg. One patient reported symptoms after CSM at the end of the active-treatment phase. The mean SBP decrease at the end of the active-treatment phase was 36+/-9 mmHg. The mean 24-hour ambulatory BP at the end of the treatment phase was 133/75+/-7/6 mmHg. The differences in symptom reporting and mean SBP decrease after CSM were both significant (P<.01 and P=.03, respectively).

CONCLUSION

The results of this pilot study suggest that treatment of vasodepressor CSS with midodrine significantly reduced the rate of symptom reporting and attenuated SBP decreases after CSM but increased mean 24-hour ambulatory BP.

Authors+Show Affiliations

Moore A
Clinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland. alanmoore@elivefree.net <alanmoore@elivefree.net>
Watts M
No affiliation info available
Sheehy T
No affiliation info available
Hartnett A
No affiliation info available
Clinch D
No affiliation info available
Lyons D
No affiliation info available

MeSH

Accidental FallsAgedAged, 80 and overBlood PressureCross-Over StudiesDouble-Blind MethodFemaleHeart RateHumansMaleMidodrinePhotoplethysmographyPlacebosProspective StudiesSyncopeTreatment OutcomeVasoconstrictor Agents

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15667387

Citation

Moore, Allan, et al. "Treatment of Vasodepressor Carotid Sinus Syndrome With Midodrine: a Randomized, Controlled Pilot Study." Journal of the American Geriatrics Society, vol. 53, no. 1, 2005, pp. 114-8.
Moore A, Watts M, Sheehy T, et al. Treatment of vasodepressor carotid sinus syndrome with midodrine: a randomized, controlled pilot study. J Am Geriatr Soc. 2005;53(1):114-8.
Moore, A., Watts, M., Sheehy, T., Hartnett, A., Clinch, D., & Lyons, D. (2005). Treatment of vasodepressor carotid sinus syndrome with midodrine: a randomized, controlled pilot study. Journal of the American Geriatrics Society, 53(1), 114-8.
Moore A, et al. Treatment of Vasodepressor Carotid Sinus Syndrome With Midodrine: a Randomized, Controlled Pilot Study. J Am Geriatr Soc. 2005;53(1):114-8. PubMed PMID: 15667387.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of vasodepressor carotid sinus syndrome with midodrine: a randomized, controlled pilot study. AU - Moore,Allan, AU - Watts,Michael, AU - Sheehy,Tina, AU - Hartnett,Ann, AU - Clinch,David, AU - Lyons,Declan, PY - 2005/1/26/pubmed PY - 2005/3/9/medline PY - 2005/1/26/entrez SP - 114 EP - 8 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 53 IS - 1 N2 - OBJECTIVES: To evaluate the efficacy of treatment of the vasodepressor form of carotid sinus hypersensitivity (carotid sinus syndrome (CSS)) with midodrine. DESIGN: A prospective, double-blind, randomized, controlled trial of crossover design. SETTING: A dedicated outpatient facility with access to tilt-table, digital arterial photoplethysmography, and 24-hour ambulatory blood pressure (BP) monitoring equipment. PARTICIPANTS: Ten older adults (4 male, 6 female, mean age 75, range 66-86 years) with a history of unexplained syncope who displayed an asymptomatic decrease in systolic BP (SBP) of more than 50 mmHg or a symptomatic decrease of more than 30 mmHg within 30 seconds of carotid sinus massage (CSM). MEASUREMENTS: Symptom reproduction and BP and heart rate changes were evaluated after CSM in supine and semierect positions on the right and then left sides. These measurements were performed on the final day of placebo and active-treatment phases. Ambulatory 24-hour BP monitoring took place on the penultimate and final days of each treatment phase. RESULTS: Eight patients were symptomatic after their initial CSM. The mean+/-standard deviation SBP decrease after initial CSM was 54+/-22 mmHg. Initial mean 24-hour ambulatory BP was 127/70+/-7/5 mmHg. Eight patients reported symptoms after CSM at the end of the placebo phase. The mean SBP decrease at the end of the placebo phase was 49+/-12 mmHg. The mean 24-hour ambulatory BP was 127/69+/-9/7 mmHg. One patient reported symptoms after CSM at the end of the active-treatment phase. The mean SBP decrease at the end of the active-treatment phase was 36+/-9 mmHg. The mean 24-hour ambulatory BP at the end of the treatment phase was 133/75+/-7/6 mmHg. The differences in symptom reporting and mean SBP decrease after CSM were both significant (P<.01 and P=.03, respectively). CONCLUSION: The results of this pilot study suggest that treatment of vasodepressor CSS with midodrine significantly reduced the rate of symptom reporting and attenuated SBP decreases after CSM but increased mean 24-hour ambulatory BP. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/15667387/Treatment_of_vasodepressor_carotid_sinus_syndrome_with_midodrine:_a_randomized_controlled_pilot_study_ DB - PRIME DP - Unbound Medicine ER -