Head-up tilt test was introduced in clinical practice to assess
vasovagal syncope and its use has further been extended to evaluate the efficacy of
drug administration in these patients. Nevertheless, the effects of tilt test on
vasovagal syncope have never been compared with those obtained by ethylephrine or
propranolol administration. One hundred and sixty-nine consecutive patients with
vasovagal syncope and positive baseline or
nitrate-potentiated tilt test (60 degrees upright position for 45 min, or until
syncope occurred; 5 mg sublingual
isosorbide dinitrate administration if no symptoms occurred) were randomly distributed among three groups: Group A (57 control patients discharged without medical therapy); Group B (56 patients discharged with 75 mg/die ethylephrine); Group C (56 patients discharged with 80 mg/die
propranolol). Tilt test was repeated after 1 month, while clinical outcome was evaluated monthly for a mean follow-up of 37.1 +/- 15.6 months. No significant differences in acute tilt-induced
syncope recurrence rates were obtained among groups at test repetition since 70.2% of Group A, 69.6% of Group B and 62.5% of Group C experienced
syncope. At 3-year follow-up 82.4% of Group A, 83.9% of Group B and 87.5% of Group C (NS among groups) remained symptom free, the most important clinical result being obtained in untreated patients. These data suggest that tilt test execution may prevent
syncope recurrence as ethylephrine or
propranolol administration. Irrespective of the therapeutical choice, the "controlled reproduction" of symptoms and some psychophysical training of patients to avoid precipitating circumstances, to recognize early symptoms promptly to be reverted by Trendelemburg position, may produce the same clinical improvement as (empiric) ethylephrine or
propranolol therapy.