[Comparative efficacy and tolerance of atenolol and midodrine in patients with vasovagal syncopes].
OBJECTIVE
To compare efficacy and tolerance of atenolol and midodrine in patients with vasovagal syncopes (VVS).


METHODS
The trial included 35 patients with recurrent VVS confirmed at long passive head-up tilt table test (HTTT) or maximal load bicycle exercise test (MET). These tests were also used for assessing efficacy of atenolol and midodrine in cases when syncopes occur in repeated tests. If recurrent induction of VVS was absent, efficacy of the drugs was assessed by long-term (up to 12 months) clinical observation. Long-term administration of atenolol and midodrine was continued in patients with effect by HTTT and/or MET. Eighteen patients were randomized to take atenolol in a daily dose up to 50 mg, seventeen--to take midodrine in a daily dose up to 15 mg.


RESULTS
Efficacy of atenolol by HTTT and MET was 8%, midodrine--57% (p = 0.01). All the patients benefited from the drugs in their long-term regimen. Long-term administration of atenolol induced remission of VVS in 82% cases, midodrine--in 89% (insignificant). Overall efficacy of atenolol was 44%, of midodrine--70% (insignificant). In 5 of 6 patients resistant to atenolol and midodrine monotherapy, combined use of the drugs was effective. Treatment with atenolol, midodrine and their combination prevented VVS in 89% patients. Both short- and long-term courses of atenolol and midodrine were safe in terms of side effects.


CONCLUSIONS
Atenolol and midodrine as well as their combination were highly effective and well tolerated in the treatment of VVS patients.
Kuchinskaia
E A
EA
Pevzner
A V
AV
Vershuta
E V
EV
Al'bitskaia
K V
KV
Kheĭmets
G I
GI
Rogoza
A N
AN
Golitsyn
S P
SP
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001262:Atenolol / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D019462:Syncope, Vasovagal / Q000188:drug therapy* / Q000503:physiopathology; D018667:Tilt-Table Test; D013997:Time Factors; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D000319:Adrenergic beta-Antagonists; D001262:Atenolol; D008879:Midodrine