Blood pressure · 2026
The effect of fludrocortisone and midodrine on ambulatory blood pressure biomarkers and symptoms of syncope.
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Doyle Kate, Rice Ciara P, Kenny Rose Anne, Briggs Robert, Lavan Amanda H
Аннотация
INTRODUCTION: Fludrocortisone and midodrine are frequently used to raise blood pressure (BP) in patients with vasovagal syncope (VVS)/low BP phenotype and orthostatic hypotension (OH), despite limited supporting evidence. This study assesses changes in Ambulatory Blood Pressure Monitor (ABPM) biomarkers and symptoms of syncope after commencing/increasing fludrocortisone or midodrine.
METHODS: Patients attending a tertiary-referral falls & syncope unit and prescribed fludrocortisone/midodrine were included. ABPM at index visit and follow-up (after commencing/increasing fludrocortisone/midodrine) were analysed, with specific focus on biomarkers of syncope risk: overall systolic BP (sBP), minimum sBP, and 'dips' in sBP <100 mmHg. Symptoms of presyncope and syncope were assessed at follow-up. These variables were compared pre and post medication changes using paired t-tests.
RESULTS: 110 patient reviews (median age 57.0 (95%CI 46.4-63.8) years, 77% female) were followed for median 4.0 (IQR 2.0-8.0) months. Of these, 52% (57/110) commenced/increased fludrocortisone, and 48% (53/110) commenced/increased midodrine. Fludrocortisone use was associated with significant increases in overall sBP, minimum sBP and reduction in sBP dips <100mmHg. Symptoms of presyncope improved in 73.7% participants commencing/increasing fludrocortisone. Only 9/27 outcomes reached statistical significance in participants commencing/increasing midodrine: overall sBP increase commencing midodrine, overall sBP increase increasing midodrine (including subgroup ≥65 years), overall sBP increase commencing/increasing midodrine (including subgroup ≥65 years), minimum sBP increase commencing midodrine (including subgroup <65 years), decrease in sBP dips <100mmHg in subgroup aged ≥65 years increasing midodrine, and decrease in sBP dips <100mmHg in subgroup ≥65 years commencing/increasing midodrine. Symptoms of presyncope improved in 64.2% participants commencing/increasing midodrine.
CONCLUSION: This study provides clinical data on the effectiveness of fludrocortisone and midodrine in patients with VVS/low BP phenotype and OH. Both fludrocortisone and midodrine significantly improved markers of future syncope risk, with fludrocortisone use showing a relatively greater effect.
METHODS: Patients attending a tertiary-referral falls & syncope unit and prescribed fludrocortisone/midodrine were included. ABPM at index visit and follow-up (after commencing/increasing fludrocortisone/midodrine) were analysed, with specific focus on biomarkers of syncope risk: overall systolic BP (sBP), minimum sBP, and 'dips' in sBP <100 mmHg. Symptoms of presyncope and syncope were assessed at follow-up. These variables were compared pre and post medication changes using paired t-tests.
RESULTS: 110 patient reviews (median age 57.0 (95%CI 46.4-63.8) years, 77% female) were followed for median 4.0 (IQR 2.0-8.0) months. Of these, 52% (57/110) commenced/increased fludrocortisone, and 48% (53/110) commenced/increased midodrine. Fludrocortisone use was associated with significant increases in overall sBP, minimum sBP and reduction in sBP dips <100mmHg. Symptoms of presyncope improved in 73.7% participants commencing/increasing fludrocortisone. Only 9/27 outcomes reached statistical significance in participants commencing/increasing midodrine: overall sBP increase commencing midodrine, overall sBP increase increasing midodrine (including subgroup ≥65 years), overall sBP increase commencing/increasing midodrine (including subgroup ≥65 years), minimum sBP increase commencing midodrine (including subgroup <65 years), decrease in sBP dips <100mmHg in subgroup aged ≥65 years increasing midodrine, and decrease in sBP dips <100mmHg in subgroup ≥65 years commencing/increasing midodrine. Symptoms of presyncope improved in 64.2% participants commencing/increasing midodrine.
CONCLUSION: This study provides clinical data on the effectiveness of fludrocortisone and midodrine in patients with VVS/low BP phenotype and OH. Both fludrocortisone and midodrine significantly improved markers of future syncope risk, with fludrocortisone use showing a relatively greater effect.