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Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity.
Am Heart J. 1998 Aug; 136(2):264-8.AH

Abstract

BACKGROUND

In patients affected by carotid sinus hypersensitivity, long-term vasodilator therapy might increase the risk of syncopal episodes by reducing systolic blood pressure and venous return to the heart.

METHODS AND RESULTS

Thirty-two patients (mean age 73 +/- 9 years; 20 men) who met all the following criteria were included: (1) one or more episodes of syncope occurring during long-term (>6 months) treatment with angiotensin-converting enzyme inhibitors, long-acting nitrates, calcium antagonists, or a combination of these; (2) a positive response to carotid sinus massage, defined as the reproduction of spontaneous syncope in the presence of ventricular asystole > or =3 seconds or a fall in systolic blood pressure > or =50 mm Hg; (3) negative workup for other causes of syncope. The patients were randomly assigned to continue or to discontinue use of vasodilators; carotid sinus massage was repeated 2 weeks after randomization. By the end of the study period, the baseline values of systolic blood pressure were significantly different between the 2 groups of patients both in supine (P=.01) and upright (P=.03) positions. Syncope had been induced by carotid sinus massage in 81% of patients in the "on-vasodilator" group and in 62% of patients in the "off-vasodilator" group (P=.21). The cardioinhibitory reflex was of similar magnitude in the 2 groups, being found in 50% of the patients in each group, with a maximum ventricular pause of 7.1 +/- 2.7 and 6.7 +/- 1.8 seconds, respectively. The percentage decrease of blood pressure did not differ between the 2 groups, even if, in absolute values, the baseline difference of blood pressure roughly persisted for the duration of the test. In consequence of that, the rise of blood pressure to similar values was delayed approximately 30 seconds in the "on-vasodilator" group and took more than 2 minutes to return to baseline values.

CONCLUSIONS

In patients affected by carotid sinus hypersensitivity, chronic vasodilator therapy does not have a direct effect on carotid sinus reflexivity, although the delayed recovery of pretest blood pressure values could indirectly potentiate the severity of the clinical manifestations of the syndrome. The persistence of hypotension for a longer time after the end of the massage suggests that vasodilators cause an impairment of compensatory mechanisms.

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Authors+Show Affiliations

Brignole M
Section of Arrhythmology, Ospedali Riuniti, Lavagna, Italy. Brignole@omninet.it
Menozzi C
No affiliation info available
Gaggioli G
No affiliation info available
Musso G
No affiliation info available
Foglia-Manzillo G
No affiliation info available
Mascioli G
No affiliation info available
Fradella G
No affiliation info available
Bottoni N
No affiliation info available
Mureddu R
No affiliation info available

MeSH

AgedAged, 80 and overBlood PressureCarotid SinusFemaleHeart ArrestHomeostasisHumansLong-Term CareMaleMassageMiddle AgedPressoreceptorsReflex, AbnormalRisk FactorsSyncopeSyndromeVasodilator AgentsVenous Pressure

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9704688

Clinical Trial Links

Stop Vasodepressor Drugs in Reflex Syncope

Citation

Brignole, M, et al. "Effects of Long-term Vasodilator Therapy in Patients With Carotid Sinus Hypersensitivity." American Heart Journal, vol. 136, no. 2, 1998, pp. 264-8.
Brignole M, Menozzi C, Gaggioli G, et al. Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity. Am Heart J. 1998;136(2):264-8.
Brignole, M., Menozzi, C., Gaggioli, G., Musso, G., Foglia-Manzillo, G., Mascioli, G., Fradella, G., Bottoni, N., & Mureddu, R. (1998). Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity. American Heart Journal, 136(2), 264-8.
Brignole M, et al. Effects of Long-term Vasodilator Therapy in Patients With Carotid Sinus Hypersensitivity. Am Heart J. 1998;136(2):264-8. PubMed PMID: 9704688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity. AU - Brignole,M, AU - Menozzi,C, AU - Gaggioli,G, AU - Musso,G, AU - Foglia-Manzillo,G, AU - Mascioli,G, AU - Fradella,G, AU - Bottoni,N, AU - Mureddu,R, PY - 1998/8/15/pubmed PY - 1998/8/15/medline PY - 1998/8/15/entrez SP - 264 EP - 8 JF - American heart journal JO - Am Heart J VL - 136 IS - 2 N2 - BACKGROUND: In patients affected by carotid sinus hypersensitivity, long-term vasodilator therapy might increase the risk of syncopal episodes by reducing systolic blood pressure and venous return to the heart. METHODS AND RESULTS: Thirty-two patients (mean age 73 +/- 9 years; 20 men) who met all the following criteria were included: (1) one or more episodes of syncope occurring during long-term (>6 months) treatment with angiotensin-converting enzyme inhibitors, long-acting nitrates, calcium antagonists, or a combination of these; (2) a positive response to carotid sinus massage, defined as the reproduction of spontaneous syncope in the presence of ventricular asystole > or =3 seconds or a fall in systolic blood pressure > or =50 mm Hg; (3) negative workup for other causes of syncope. The patients were randomly assigned to continue or to discontinue use of vasodilators; carotid sinus massage was repeated 2 weeks after randomization. By the end of the study period, the baseline values of systolic blood pressure were significantly different between the 2 groups of patients both in supine (P=.01) and upright (P=.03) positions. Syncope had been induced by carotid sinus massage in 81% of patients in the "on-vasodilator" group and in 62% of patients in the "off-vasodilator" group (P=.21). The cardioinhibitory reflex was of similar magnitude in the 2 groups, being found in 50% of the patients in each group, with a maximum ventricular pause of 7.1 +/- 2.7 and 6.7 +/- 1.8 seconds, respectively. The percentage decrease of blood pressure did not differ between the 2 groups, even if, in absolute values, the baseline difference of blood pressure roughly persisted for the duration of the test. In consequence of that, the rise of blood pressure to similar values was delayed approximately 30 seconds in the "on-vasodilator" group and took more than 2 minutes to return to baseline values. CONCLUSIONS: In patients affected by carotid sinus hypersensitivity, chronic vasodilator therapy does not have a direct effect on carotid sinus reflexivity, although the delayed recovery of pretest blood pressure values could indirectly potentiate the severity of the clinical manifestations of the syndrome. The persistence of hypotension for a longer time after the end of the massage suggests that vasodilators cause an impairment of compensatory mechanisms. SN - 0002-8703 UR - https://www.unboundmedicine.com/medline/citation/9704688/Effects_of_long_term_vasodilator_therapy_in_patients_with_carotid_sinus_hypersensitivity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(98)00155-0 DB - PRIME DP - Unbound Medicine ER -