METHODS

Design:

randomised controlled trial (Physical Counterpressure Manoeuvres Trial).

Allocation:

concealed.*

Blinding:

blinded (patients).*

Follow up period:

mean 14 months.

Setting:

15 medical centres worldwide.

Patients:

223 patients who were 16–70 years of age with recurrent vasovagal syncope (⩾3 syncope episodes in the past 2 y or ⩾1 syncopal spell and 3 pre-syncopal episodes in the past y) or a suspected diagnosis confirmed by tilt table testing and who had recognisable prodromal symptoms and a normal physical examination and electrocardiogram. Exclusion criteria included suspected or overt heart disease with a high likelihood of cardiac syncope; orthostatic hypotension; loss of consciousness different from syncope; the …