New approach to hypotensive susceptibility in reflex syncope induced by
tilt testing
Abstract
Introduction Why some individuals with similar demographic
characteristics develop syncope during tilt testing (TT) and others do
not is unknown and low test sensitivity is claimed. We sought an
alternative explanation; resting cardiovascular physiology differs in
patients with positive and negative TT. Methods We analyzed age, gender,
systolic (SBP), diastolic blood pressure (DBP), and heart rate (HR)
using three large syncope patient databases comparing tilt-positive with
tilt-negative results after excluding orthostatic hypotension. Positive
tilt-response, confirming reflex syncope, was defined as reproduction of
spontaneous symptoms with characteristic bradycardia and/or hypotension.
Impact of demographic, hemodynamic parameters and prevalent hypertension
on TT positivity were assessed using logistic regression models. Results
Records of 5236 patients (45% males; mean age, 60±22 years; 32% on
antihypertensive therapy) were analyzed. TT was positive in 3129 (60%)
and tilt-positive patients had lower SBP (127.2±17.9 vs 129.7±18.0 mmHg,
p<0.001), DBP (76.2±11.5 vs 77.7±11.7 mmHg, p<0.001)
and HR (68.0±11.5 vs 70.5±12.5 bpm, p<0.001) compared with
tilt-negative patients. SBP was similar in males and females but males
had higher DBP and lower HR than females (p<0.001). In
multivariable analysis, tilt-test positivity was independently
associated with younger age (p=0.016), SBP≤128 mmHg (p<0.001),
HR≤69 bpm (p<0.001), and absence of hypertension
(p<0.001). Conclusions Patients developing reflex syncope
during tilt-testing have lower systolic and diastolic blood pressure and
heart rate compared with tilt-negative patients. Tilt-test positivity is
independently associated with younger age, lower blood pressure, lower
heart rate and absence of hypertension but not with gender. These
hemodynamic differences imply hypotensive susceptibility.