Deprescribing of blood pressure-lowering medications in patients with hypotensive syncope.

Authors

Vincenzo Russo, Erika Parente, Angelo Comune, Antonella Groppelli, Jaume Francisco-Pascual, Nuria Rivas-Gándara, Jean-Claude Deharo, Baptiste Maille, Frederik J De Lange, Thomas T Boel, Giulia Rivasi, Mattia Laffi, Roberto Maggi, Rose Anne Kenny, Artur Fedorowski, Gianfranco Parati, Michele Brignole

Published in

European journal of internal medicine. Pages 107119. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

To assess the efficacy of deprescribing blood pressure-lowering medications in hypertensive patients suffering from severe hypotensive syncope.
Multicentre, prospective, pragmatic, non-randomized uncontrolled, study. Deprescribing (withdrawal or dose reduction of antihypertensive and psychoactive medications with blood pressure lowering effects) was guided by clinical experience and supported by two 24-hour ambulatory blood pressure monitoring (ABPM) assessments-one before (ABPM 1) and one after (ABPM 2) drug optimization. Primary endpoint was the reduction of the burden of syncope.
In a cohort of 92 patients (mean age 76.6 ± 12.1 years, 53% female), the total number of hypotensive medications decreased from 218 (2.4 ± 1.1 per patient) before deprescribing to 123 (1.3 ± 1.0 per patient) after the intervention. The 24-hour systolic blood pressure increased from 118.8 ± 10.8 mmHg at ABPM 1 to 127.5 ± 11.6 at ABPM 2 (p = 0.0001). The number of daytime SBP drops <90 mmHg and <100 mmHg decreased by 52%, (from 208 to 100) and 53% (from 601 to 280), respectively (p = 0.0001 for both). During the mean follow-up of 12.6 ± 3.8 months (range 2 to 21 months), 28 patients (30.4%) had syncopal recurrences. Excluding the index episode, patients experienced 111 episodes in the year before enrolment and 41 during the overall follow-up. The syncope burden dropped by 66%, from 0.08 (IQR 0-0.17) to 0 (IQR 0-0.07) episodes per month (p = 0.0001).
In patients with hypertension and hypotensive syncope deprescribing of blood pressure lowering medications reduced hypotensive episodes and syncopal recurrences. However, the findings preclude firm causal inferences.

PMID:
42580907
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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