β-Adrenergic receptor blockers are one of a number of therapeutic agents promoted as having beneficial effects in vasovagal syncope. In this issue of Clinical Science, Eldadah and co-workers have investigated the effect of the β-adrenergic receptor blocker propranolol in preventing syncope in a double-blind cross-over trial in eight subjects with a diagnosis based on tilt table testing and elevated plasma adrenaline levels during syncope. Of these, seven did not respond and the authors therefore suggest that this drug has no role in the management of vasovagal syncope. Their laboratory-based study, however, raises a number of issues regarding terminology, choice of subjects, the value and role of investigations directed towards diagnosis and in understanding pathophysiological mechanisms, and the relevance of such trials to individual subjects with vasovagal syncope.
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Commentary| August 15 2006
β-Adrenergic receptor blockers and the treatment of vasovagal syncope: more nails in the coffin!
Christopher J. Mathias
1Neurovascular Medicine Unit, Faculty of Medicine, Imperial College London at St Mary's Hospital, Praed Street, London W2 1NY, U.K., and Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, Institute of Neurology, University College London, London WG1N 3BG, U.K.
Correspondence: Professor Christopher J. Mathias, at the Neurovascular Medicine Unit, Imperial College London at St Mary's Hospital, Praed Street, London W2 1NY, U.K. (email firstname.lastname@example.org).
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Christopher J. Mathias; β-Adrenergic receptor blockers and the treatment of vasovagal syncope: more nails in the coffin!. Clin Sci (Lond) 1 September 2006; 111 (3): 189–191. doi: https://doi.org/10.1042/CS20060174
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