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- W2071129930 abstract "Although β-blockers are preferred agents for therapy of vasodepressor syncope (VDS), they are not uniformly effective and their mechanism of action is incompletely understood. Since we have previously shown a differential therapeutic response to β-blocker therapy between pts with isoproterenol-independent [iso(-)] and isoproterenol-dependent [iso(+)] VDS during tilt table testing we sought to determine whether this was due to a differential heart rate (HR) response to orthostasis during β-blockade. We therefore examined immediate HR and blood pressure responses to upright tilt before and after initiation of therapy with atenolol (12.5–50 mg daily) in 62 pts with VDS and positive tilt tests. The protocol comprised upright tilt (60°) for up to 60 min followed by repeat tilt for 15 min during isoproterenol (iso) infusion. Supine HR, mean arterial pressure (MAP) and pulse pressure (PP) were determined as the mean of 3 consecutive 1-min samples during supine rest; orthostatic HR, MAP, and PP were the mean of the samples recorded in the first 3 min after upright tilt (before infusion of iso). Response to atenolol required completion of tilt with and without infusion of iso. There were 15 iso(-) pts and 47 iso(+) pts. The groups did not differ significantly in blood pressure response (MAP, PP) to orthostasis. Supine HR fell and the ΔHR in response to orthostasis was blunted during therapy in both groups:Empty CellBaseline (Mean ± SD)Rx (Mean ± SD)Iso(+)Iso(-)pIso(+)Iso(-)pSupine HR69 ± 1368 ± 9NS57 ± 958 ± 8NSOrthostatic ΔHR8 ± 712 ± 9NS3 ± 53 ± 4NS 11 iso(-) pts (73%) had a therapeutic response to β-blockade compared with 46 iso(+) pts (98%, p = 0.01); the orthostatic ΔHR in the iso(-) pts who failed β-blocker therapy was no different from the response in the patients with a therapeutic response. The HR response to orthostasis is comparably blunted after β-blockade in pts with iso(-) and iso(+) VDS, indicating that failure to respond is not due to inadequate β-blockade and suggests that in some pts iso-independent VDS may be independent of a cardiac β1 receptor mediated mechanism." @default.
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- W2071129930 date "1995-02-01" @default.
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- W2071129930 title "976-14 Immediate Heart Rate Response to Orthostatic Stress During β -blocker Therapy for Vasodepressor Syncope" @default.
- W2071129930 doi "https://doi.org/10.1016/0735-1097(95)92521-6" @default.
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