title: Poor diagnostic performance of tilt testing in hypertensive patients with unexplained syncope.
abstract: Syncope is a common condition. Tilt testing with sublingual nitroglycerin (TT-TNT) provides a test with good specificity and positivity rate in young and old patients. Its use in hypertensive patients with unexplained syncope has not been validated. The aims of this study were to evaluate the positivity rate, specificity and tolerability of TT-TNT in hypertensive patients with unexplained syncope. Five hundred and ten subjects (mean age 55 years) were enrolled, 388 patients with unexplained syncope (73 hypertensive and 315 normotensive) and 122 controls (59 hypertensive and 63 normotensive). All subjects underwent TT-TNT. The responses were classified as positive, negative or exaggerated (aspecific). In hypertensive patients, the usual hypotensive therapy was taken on the day of the test. In hypertensive controls, the positive responses were higher than in normotensives (19% vs 6%, P<0.001). The overall specificity was 81% in hypertensives and 94% in normotensives. The positivity rate was significantly lower in hypertensives (55% vs 72%, P<0.03). There was no significant difference between young patients and patients >65 years. TT was well tolerated, and no serious side effects occurred. TT potentiated with TNT has a lower positivity rate and specificity in hypertensive than in normotensive patients with syncope.
authors.affiliation: 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ungar
authors.affiliation: 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rafanelli
authors.affiliation: 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Cellai
authors.affiliation: 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ceccofiglio
authors.affiliation: Division of Cardiology, Ospedale San Giuseppe, Empoli, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Del Rosso
authors.affiliation: Geriatric and Gerontology Institute, University of Modena, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mussi
authors.affiliation: 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Marchionni
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001341:Autonomic Nervous System / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D018667:Tilt-Table Test / Q000379:methods*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin