Key result
Twenty-four-hour ABPM identifies a hypotensive phenotype in ~83% of suspected reflex syncope cases to guide therapy.
Why the study?
Does 24-hour ambulatory blood pressure monitoring improve the identification of the hypotensive phenotype and guide therapy to prevent recurrences in patients with vasovagal syncope?
Does 24-hour ambulatory blood pressure monitoring improve the identification of the hypotensive phenotype and guide therapy to prevent recurrences in patients with vasovagal syncope?
24-hour ABPM plays a central diagnostic and therapeutic role in vasovagal syncope by identifying underlying hypotensive phenotypes and guiding targeted blood pressure management to prevent syncope recurrences.
ABPM may aid hypotensive phenotype detection in reflex syncope; leaves open whether it reduces recurrences without randomized confirmation.
The haemodynamic mechanisms underlying vasovagal (reflex) syncope include hypotension and extrinsic asystole/bradycardia, corresponding to two distinct haemodynamic phenotypes of syncope, i.e., the hypotensive and the bradycardic phenotypes. The hypotensive phenotype is the most prevalent, being observed in the 83% of patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) demonstrated high effectiveness in identifying the hypotensive phenotype in patients with suspected reflex syncope. The diagnosis of a hypotensive mechanism of syncope is supported by ABPM when one or more of the following criteria are present: Constitutional hypotension: 24-h systolic blood pressure (SBP) <105 mmHg in men and <98 in womenDrug-related hypotension: 24-h SBP <120 mmHgHypotensive episodes: ≥1 daytime SBP <90 mmHg or ≥2 daytime SBP <100 mmHgPostprandial hypotension: symptomatic SBP fall >20 mmHg or absolute value <90 mmHg within 75 min of meals ABPM also plays a key role in guiding therapy. In hypertensive patients with hypotensive syncope, deprescribing antihypertensive medications is indicated with the goal of increasing 24-hour average SBP to ≥ 134 mmHg and/or by at least ≥12 mmHg, without exceeding 140 mmHg (or <160 mmHg in frail older patients). In patients with drug-unrelated hypotension, lower-body elastic garments, fludrocortisone, or midodrine - prescribed singularly or in combination - may be considered and targeted to achieve a 24-hour average SBP ≥116 mmHg and/or an increase of at least ≥9 mmHg.
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Brignole et al. (2026) conducted a review in Vasovagal (reflex) syncope. 24-h ambulatory blood pressure monitoring (ABPM) was evaluated. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) effectively identifies the hypotensive phenotype in 83% of patients with suspected reflex syncope and guides subsequent therapy.
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