POST-2
Prevention of Syncope Trial 2
Patient / Population Intervention / Exposure Comparison Outcome
In 210 patients with recurrent vasovagal syncope, fludrocortisone did not significantly reduce the first recurrence of syncope over one year compared with placebo, although a benefit emerged once the dose had been stabilised.
N
210patients
Design
Double-blind, placebo-controlled RCT
Endpoint
Time to first recurrence of syncope over 1 year
Relevance
3Supporting — context rather than must-know.
ResultHR 0.69 (95 % CI 0.46–1.03; p=0.069) — the prespecified 40 % relative risk reduction was not met. Restricted to the period after dose stabilisation, HR 0.51 (95 % CI 0.28–0.89; p=0.019).
Sheldon R, Raj SR, Rose MS, et al. J Am Coll Cardiol. 2016;68(1):1-9. 10.1016/j.jacc.2016.04.030
Cited in guidelines
Discussion & critique
It formally missed its primary endpoint and the supportive analyses are post hoc, so the effect is fragile. It is nonetheless the largest randomised evidence for fludrocortisone and underpins its class-IIb place in young patients with low blood pressure.