de Lange Frederik J, van Zanten Steven, Rivasi Giulia, Groppelli Antonella, Russo Vincenzo, Maggi Roberto, Capacci Marco, Nawaz Sara, Comune Angelo, Ungar Andrea, Parati Gianfranco, Brignole Michele, Fedorowski Artur
Amsterdam UMC, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
Reinier de Graaf Gasthuis, Department of Cardiology, Cardiology and Syncope Unit, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands.
Clin Auton Res. 2025 Jun;35(3):523-527. doi: 10.1007/s10286-024-01096-3. Epub 2024 Dec 24.
The study aimed to assess the haemodynamic effects of fludrocortisone and midodrine, alone or combined, in patients with recurrent syncope and/or symptoms due to hypotension and ≥ 1 daytime systolic blood pressure (SBP) drop < 90 mmHg or ≥ 2 daytime SBP drops < 100 mmHg recorded by 24-h ambulatory blood pressure monitoring (ABPM1).
A total of 53 patients (mean age, 40.9 ± 18.5 years, 37 female) were treated with fludrocortisone (0.05-0.2 mg per day) and/or midodrine (2.5-10 mg two or three times per day). A second ABPM (ABPM2) was performed within 6 months and the results of ABPM1 AND ABPM2 were compared to assess the effects of BP-rising drugs.
In 32 patients assigned to fludrocortisone, 24-h SBP increased from 107.1 ± 9.9 mmHg to 116.3 ± 14.9 (p = 0.0001), the number of daily SBP drops < 90 mmHg decreased by 73% (p = 0.0001) and that of drops < 100 mmHg decreased by 41% (p = 0.0005). In 14 patients assigned to midodrine, 24-h SBP increased from 112.7 ± 7.4 mmHg to 115.0 ± 9.1 (p = 0.12), the number of daily SBP drops < 90 mmHg decreased by 52% (p = 0.04) and that of drops < 100 mmHg decreased by 34% (p = 0.007). In the seven patients taking both fludrocortisone and midodrine, 24-h SBP increased from 110.1 ± 11.5 mmHg to 114.0 ± 12.4 (p = 0.002), the number of daily SBP drops < 90 mmHg decreased by 69% (p = 0.22) and that of drops < 100 mmHg decreased by 44% (p = 0.04).
Both fludrocortisone and midodrine effectively increased 24-h SBP and reduced SBP drops on ABPM but fludrocortisone seemed to be more effective than midodrine. Further randomised studies are needed to confirm these observations.
本研究旨在评估氟氢可的松和米多君单独或联合使用对反复晕厥和/或因低血压导致症状的患者的血流动力学影响，这些患者24小时动态血压监测（ABPM1）记录到≥1次日间收缩压（SBP）下降<90 mmHg或≥2次日间SBP下降<100 mmHg。
共53例患者（平均年龄40.9±18.5岁，女性37例）接受氟氢可的松（每日0.05 - 0.2 mg）和/或米多君（每日2.5 - 10 mg，每日两次或三次）治疗。在6个月内进行第二次ABPM（ABPM2），并比较ABPM1和ABPM2的结果以评估升压药物的效果。
在32例接受氟氢可的松治疗的患者中，24小时SBP从107.1±9.9 mmHg升至116.3±14.9 mmHg（p = 0.0001），每日SBP下降<90 mmHg的次数减少73%（p = 0.0001），下降<100 mmHg的次数减少41%（p = 0.0005）。在14例接受米多君治疗的患者中，24小时SBP从112.7±7.4 mmHg升至115.0±9.1 mmHg（p = 0.12），每日SBP下降<90 mmHg的次数减少52%（p = 0.04），下降<100 mmHg的次数减少34%（p = 0.007）。在7例同时服用氟氢可的松和米多君的患者中，24小时SBP从110.1±11.5 mmHg升至114.0±12.4 mmHg（p = 0.002），每日SBP下降<90 mmHg的次数减少69%（p = 0.22），下降<100 mmHg的次数减少44%（p = 0.04）。
氟氢可的松和米多君均能有效提高24小时SBP并减少ABPM中的SBP下降，但氟氢可的松似乎比米多君更有效。需要进一步的随机研究来证实这些观察结果。
