Targets for deprescribing in patients with hypertension and reflex syncope

Eur J Intern Med. 2024 Oct:128:40-44. doi: 10.1016/j.ejim.2024.05.014. Epub 2024 May 24.

Abstract

Background: We aimed to identify the target of deprescribing, i.e. the 24-hour SBP increase needed to achieve the greatest reduction of SBP drops.

Method: Forty hypertensive patients (mean age 73.6 ± 9.3 years, 26 females) with reflex syncope and SBP drops on a screening ABPM were advised to withdraw or to reduce their therapy. The study objective was the reduction of SBP drops <90 mmHg and <100 mmHg on a second ABPM performed within 3 months.

Results: Out of a total of 98 drugs taken during ABPM 1, 44 were withdrawn, 16 had a dose reduction and 38 remained unchanged at the time of ABPM 2. 24-hour SBP increased from 119.7 ± 10.1 mmHg to 129.4 ± 13.2 mmHg during ABPM2. Total disappearance of daytime SBP drops <100 mmHg was achieved in 20 (50 %) patients who had 24-hour SBP of 134±13 mmHg and an increase from ABPM 1 of 12 (IQR 5-20) mmHg. Compared with the 20 patients who had persistence of drops, these patients had a greater reduction of the number of hypotensive drugs (67 % versus 19 %, p = 0.002) and a greater rate of withdrawals (62 % versus 29 %, p = 0.003).

Conclusion: In hypertensive patients with reflex syncope, an increase of 12 mmHg and an absolute value of 24-hour SBP of 134 mmHg appear to represent the optimal goals aimed to prevent SBP drops. Drugs withdrawal, rather than simply dose reduction, is mostly required to achieve the above target.

Keywords: 24 h ambulatory blood pressure monitoring; Antihypertensive drugs; Hypertension; Reflex syncope.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents* / administration & dosage
  • Antihypertensive Agents* / therapeutic use
  • Blood Pressure Monitoring, Ambulatory*
  • Blood Pressure* / drug effects
  • Deprescriptions*
  • Female
  • Humans
  • Hypertension* / drug therapy
  • Male
  • Middle Aged
  • Syncope / drug therapy

Substances

  • Antihypertensive Agents