Efficacy of fludrocortisone for symptom relief in patients with autonomic syncope and hypotensive phenotype
Year: 2026
Type: article
Abstract: AIM: To assess the efficacy of fludrocortisone therapy in patients with autonomic syncope and hypotensive phenotype. METHODS AND RESULTS: Multicentre, prospective, non-randomized study. Fludrocortisone therapy was guided by clinician experience and supported by two 24-hour ambulatory blood pressure monitoring (ABPM) assessments-one before treatment start (ABPM 1) and one after drug optimization (ABPM 2). Primary endpoint: reduction of the syncope burden and presyncopal symptoms based on validated semi structured questionnaires. Secondary endpoint: hypotensive episodes on ABPM. In a cohort of 94 patients treated with fludrocortisone (median age 38 [IQR 21-57]) years, 83% females), 16 patients stopped therapy due to side effects, occurring during optimization (#11) or follow-up (#5). A total of 83 patients were analysed. The average 24-hour systolic blood pressure (SBP) increased from 106.3 ± 8.2 mmHg at ABPM 1 to 112.3 ± 9.3 at ABPM 2 (p = 0.0001). The number of daytime SBP drops <90 mmHg and <100 mmHg decreased by 61%, and 45% respectively (p < 0.001 for both). The annual syncope burden was reduced by 50.2%, from 2.0 (IQR 1.0-4.0) before therapy to 0.0 (IQR 0.0-1.8) episodes during a median follow-up of 12.9 months (p = 0.0001). Subjective symptom improvement was reported by 85.6% of patients. The frequency of syncope/presyncope decreased significantly, p = 0.009. The outcome was similar in 42 younger (23 ± 6 yrs) and in 41 older (56 ± 12 yrs) patients. CONCLUSION: Fludrocortisone therapy was associated with reduced hypotension and the burden of symptoms both in younger and in older patients. Side effects lead to discontinuation of therapy in 17% of cases.
Source: EP Europace
Institutions: Trinity College Dublin, St. James's Hospital, University of Campania "Luigi Vanvitelli", Ospedale Monaldi, Amsterdam University Medical Centers, University of Amsterdam, IRCCS Istituto Auxologico Italiano, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital de la Timone, Karolinska University Hospital, Karolinska Institutet, Presidio Ospedaliero, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Institut d'Investigació Sanitària Acreditat Institut de Recerca - Hospital Universitari Vall d'Hebron, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Ospedale Villa Scassi
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,909
Funder: Ministero della Salute
OpenAlex ID: W7225204632