Comparative study of the efficacy of metoprolol and verapamil in patients with syncope and positive head-up tilt test response

Jhamb, Dinesh; Sharda, B; Kaul, Upendra; Goel, Pankaj; Kk, Talwar; Wasir, Harbans S.

doi:10.1016/s0002-8703(96)90245-8

Cited by 24 publications

(7 citation statements)

References 17 publications

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“…In general, while the results have been satisfactory in uncontrolled trials or shortterm controlled trials [275][276][277][278][279][280][281][282][283][284][285][286][287][288] with few exceptions [132,289] , several long-term placebo-controlled prospective trials have been unable to show a benefit of the active drug over placebo [133,134,[290][291][292][293][294] with one exception [295] . In vasovagal syncope beta-blockers, owing to their negative inotropic effect, have been supposed to lessen the degree of mechanoreceptor activation associated with an abrupt fall in venous return and block the effects of elevated circulating adrenaline, but this theory has not been supported by facts.…”

Section: Vasovagal Syncopementioning

confidence: 99%

“…Beta-blockers may enhance bradycardia in the carotid sinus syndrome and in all other cardioinhibitory forms of neurally-mediated syncope. Beta-adrenergic blocking drugs have been claimed to be useful in many uncontrolled studies [275,[277][278][279][280][281] or in one short-term controlled study [276] , but have failed to be effective in five long-term follow-up controlled studies [290][291][292][293][294] and in one short-term controlled study [288] . Thus the evidence fails to support beta-blocker efficacy (level A).…”

Section: Vasovagal Syncopementioning

confidence: 99%

See 1 more Smart Citation

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

680

432

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Section: Vasovagal Syncopementioning

confidence: 99%

Section: Vasovagal Syncopementioning

confidence: 99%

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

680

432

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“…9,10) A review of recently published data evaluating beta-blockers for the treatment of N-M syncope has shown oral beta-blockers to be effective in 72% of patients with N-M syncope as tested by the repeat HUT test. 16,[19][20][21] Our data showed that the efficacy of Atenolol in the prevention of inducible syncope or pre-syncope is 46% (16 / 35).…”

Section: Discussionmentioning

confidence: 99%

“…Since then, the HUT test has been used extensively to diagnose N-M syncope [6][7][8] and to assess the efficacy of therapeutic interventions. 9,10) The cause of hypotension-bradycardia in patients with N-M syncope is not fully understood, but may be triggered by increased activity of ventricular mechanoreceptors secondary to enhanced sympathetic tone and empty left ventricular cavity. 11,12) Thus, we postulate that beta-blockers may be effective at preventing the occurrence of N-M syncope.…”

mentioning

confidence: 99%

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Fang

Kuo

2000

Jpn Heart J

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SUMMARYThis study included 87 consecutive patients with unexplained syncope or pre-syncope who had undergone the head-up tilt (HUT) test with concomitant isoproterenol infusion. A positive response was defined as development of syncope or pre-syncope in association with substantial hypotension (decline of systolic blood pressure > 20 mmHg). Coronary artery spasm was suggested from the clinical symptoms and electrocardiographic findings in 1 patient (1 / 87 = 1.1%). Intolerance to isoproterenol infusion was noted in 8 cases (8 / 87 = 9%). Of the 78 patients who completed the study, 73 showed positive responses (73 / 78 = 94%). (baseline systolic blood pressure = 125 ± 23 mmHg vs endpoint systolic blood pressure = 76 ± 11 mmHg, p < 0.05; baseline heart rate = 73 ± 14 beats per minute vs endpoint HR = 80 ± 24 beats per minute, p < 0.05). In 73 patients who showed positive responses, the systolic blood pressure (SBP) and heart rate (HR) returned to a safe level at 2 minutes when the patients were returned to a supine position (post-study 2 minutes SBP = 124 ± 18 mmHg vs baseline SBP = 125 ± 23 mmHg, p = NS; post-study 2 minutes HR = 82 ± 18 beats per minute vs baseline HR = 73 ± 14 beats per minute, p < 0.05). All 73 patients with a positive HUT test received Atenolol therapy (50 mg daily). Only 35 of these 73 patients took Atenolol regularly and had a repeat HUT test. After atenolol therapy, persistent positive responses were observed in 19 cases (19 / 35 = 54%) and negative responses were noted in 16 cases (16 / 35 = 46%). The mean dosage of isoproterenol needed to provoke a positive HUT test in 19 patients who had received Atenolol therapy and had a positive repeat HUT test was 2.3 ± 1.2 µg / min at baseline and 3.5 ± 0.9 µg / min for post-Atenolol therapy (p < 0.001). Sixteen patients with a negative repeat HUT test were treated continuously with Atenolol and followed for a mean period of 13 ± 11 months (range, 1-34 months). All 16 patients were free of syncope or pre-syncope during the period of follow up. In conclusion, the HUT test is mostly well tolerated and safe, even though the test has a low rate of adverse effects. Atenolol is effective for the prevention of provoked or spontaneous recurrent syncope or pre-syncope. (Jpn Heart J 2000; 41: 623-631)

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“…[80,90] It is noteworthy that verapamil, a calcium channel blocker with negative chronotropic and inotropic effects, is considerably less efficacious than β-blockers. [82] …”

Section: β-Blockersmentioning

confidence: 99%

Drug Treatment of Orthostatic Hypotension Because of Autonomic Failure or Neurocardiogenic Syncope

Lamarre-Cliché

2002

American Journal of Cardiovascular Drugs

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Orthostatic hypotension either because of autonomic failure or neurocardiogenic syncope can be very incapacitating and should be treated accordingly. Drug therapy is frequently needed to alleviate orthostatic symptoms. The physiopathological basis of neurocardiogenic syncope and of autonomic failure is completely different and their treatment should be distinct. In the past 5 years, many randomized, placebo-controlled trials have shed light on the efficacy of specific pressor drugs. In patients with orthostatic hypotension because of autonomic failure, alpha-adrenoceptor agonists, and midodrine in particular, have been shown to increase standing blood pressure and decrease orthostatic symptoms. Other drugs such as octreotide, indomethacin or ergotamine have also been shown to elevate standing blood pressure and/or orthostatic tolerance. Fludrocortisone is a well known and frequently used pressor drug but randomized controlled studies are needed to measure its efficacy. In patients with orthostatic hypotension associated with neurocardiogenic syncope, clinical trials have demonstrated that beta-blockers, especially beta(1)-selective agents without intrinsic sympathomimetic activity such as atenolol, midodrine and paroxetine can decrease recurrence of syncope. Treatment algorithms, such as those presented in this review, should always be interpreted in the light of individual patient characteristics. Many of the drugs used for orthostatic hypotension have multiple indications and contraindications that should influence therapeutic decisions. Little is known about the effectiveness and tolerability of specific combinations of pressor drugs. Consequently, sound clinical judgment and close follow-up of patients should always guide combination therapy.

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Comparative study of the efficacy of metoprolol and verapamil in patients with syncope and positive head-up tilt test response

Cited by 24 publications

References 17 publications

Guidelines on management (diagnosis and treatment) of syncope

Guidelines on management (diagnosis and treatment) of syncope

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Drug Treatment of Orthostatic Hypotension Because of Autonomic Failure or Neurocardiogenic Syncope

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