Hipotensión en pacientes con síncope: prueba de basculación y monitorización de la presión arterial en la práctica clínica

Introduction and objectives

Both ambulatory blood pressure monitoring (ABPM) and tilt-test (TT) can identify the hypotensive component that predisposes to syncope. The aim was to establish the prevalence of hypotension in ABPM and TT and to establish the concordance of the results between both methods.

Methods

Patients ≥ 18 years with syncope in whom it was decided to perform a TT (45 min at 75̊) were included. An ABPM was performed on different dates. The criteria of hypotension were: in TT, TT (+) or detection of systolic blood pressure ≤ 100 mmHg during the study, resulting from a drop respect to baseline systolic blood pressure; in ABPM, ≥ 2 falls ≥ 20 mmHg with respect to the previous one reaching systolic blood pressure ≤ 100 mmHg.

Results

A total of 61 patients were studied (62.5 ± 16.8 years, 39 women [64%]). TT was positive in 41% of the patients. Additionally, during TT, hypotension was detected in another 18% of patients and hypotension by ABPM was observed in the 51%. Combining both methods, hypotension was detected in 79% of the population (48 patients). Both studies were concordant in 32 patients (52%) (Cohen kappa index: 0.04). Hypotension was identified in 28% of patients only by TT and in 20% only by ABPM.

Conclusions

Using a strategy combining TT and ABPM, hypotension was detected in three quarters of this population with syncope. Both methods proved to be complementary not only to develop a diagnostic suspicion but also to guide the therapeutic management of these patients.