title: Randomized, double-blind, placebo-controlled trial of oral enalapril in patients with neurally mediated syncope.
abstract: BACKGROUND
  The purpose of this study was to study the effect of enalapril on neurally mediated syncope (NMS). Several agents (except for angiotensin-converting enzyme [ACE] inhibitors) have been used to treat patients with NMS. It is unknown whether ACE inhibitors have beneficial effects on NMS.
  
  
  RESULTS
  Thirty subjects who had reproducible NMS induced with head-up tilt table test (HUT) were randomly assigned and divided in double-blind fashion into placebo and enalapril (an ACE inhibitor) groups. Hemodynamics and plasma catecholamine concentrations were studied. Before administration of enalapril, syncope induced by HUT was associated with vigorous hypotension and bradycardia. Plasma catecholamine concentrations were significantly elevated during NMS compared with the supine position before tilt. Oral enalapril rather than placebo produced a marked reduction in diastolic blood pressure during supine positioning before tilt. Administration of enalapril prevented HUT-induced NMS and increase of plasma catecholamine concentrations in all patients examined. Conversely, placebo had no effect in the majority of patients with NMS (12 of 15 subjects). Follow-up data showed that NMS disappeared in 14 (93%) of 15 patients treated with enalapril.
  
  
  CONCLUSIONS
  This study demonstrates that ACE inhibitors may efficiently prevent NMS, presumably through inhibition of sympathetic system activation and peripheral hypotensive effect.
authors.affiliation: Hypertension Center and Division of Cardiology, Third Military Medical University, Daping Hospital, Chongqing, Republic of China.
authors.forename: C
authors.initials: C
authors.lastname: Zeng
authors.forename: Z
authors.initials: Z
authors.lastname: Zhu
authors.forename: G
authors.initials: G
authors.lastname: Liu
authors.forename: W
authors.initials: W
authors.lastname: Hu
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: C
authors.initials: C
authors.lastname: Yang
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.forename: D
authors.initials: D
authors.lastname: He
authors.forename: J
authors.initials: J
authors.lastname: Tan
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002395:Catecholamines / Q000097:blood; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D013575:Syncope / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002395:Catecholamines; D004656:Enalapril