Decreased orthostatic adrenergic reactivity in non-dipping postural tachycardia syndrome
Open accessAbstract
Whether non-dipping - the loss of the physiologic nocturnal drop in blood pressure - among patients with postural tachycardia syndrome (POTS) is secondary to autonomic neuropathy, a hyperadrenergic state, or other factors remains to be determined. In 51 patients with POTS (44 females), we retrospectively analyzed 24-hour ambulatory blood pressure recordings, laboratory indices of autonomic function, orthostatic norepinephrine response, 24-hour natriuresis and peak exercise oxygen consumption. Non-dipping (<10% day-night drop in systolic blood pressure) was found in 55% (n=28). Dippers and non-dippers did not differ in: 1) baseline characteristics including demographic and clinical profile, sleep duration, daytime blood pressure, 24-hour natriuresis, and peak exercise oxygen consumption; 2) severity of laboratory autonomic deficits (sudomotor, cardiovagal and adrenergic); 3) frequency of autonomic neuropathy (7/23 vs. 8/28, P=0.885); 4) supine resting heart rate (75.3±14.0bpm vs. 74.0±13.8bpm, P=0.532); or 5) supine plasma norepinephrine level (250.0±94.9pg/ml vs. 207.0±86.8pg/ml, P=0.08). However, dippers differed significantly from non-dippers in that they had significantly greater orthostatic heart rate increment (43±16bpm vs. 35±10bpm, P=0.007) and significantly greater orthostatic plasma norepinephrine increase (293±136.6pg/ml vs. 209±91.1pg/ml, P=0.028). Our data indicate that in patients with POTS, a non-dipping blood pressure profile is associated with a reduced orthostatic sympathetic reactivity not accounted for by autonomic neuropathy.
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Nondipping POTS patients demonstrate significantly greater orthostatic HR increment and a significantly greater orthostatic plasma NE rise compared with matched dipping controls.
“These patients also demonstrate significantly greater orthostatic HR increment and a significantly greater orthostatic plasma NE rise compared with matched dipping controls (56),”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [56]
The Results (Autonomic Function Tests, BP monitoring, and Laboratory Data; page not provided) report the opposite direction: dipping POTS patients had significantly greater orthostatic heart-rate increments and plasma norepinephrine increases than non-dippers. The Discussion likewise describes lower adrenergic reactivity in non-dippers. (LLM, conf=0.95)
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Cites
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Postural Orthostatic Tachycardia Syndrome
Bryarly, M., Phillips, L. T., Fu, Q., Vernino, S., & Levine, B. D. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.059 · Cited by 245 · see citing works
Mathias, C. J., Owens, A., Iodice, V., & Hakim, A. (2021) · American Journal of Medical Genetics Part C: Seminars in Medical Genetics · doi:10.1002/ajmg.c.31951 · Cited by 65 · see citing works
- Authors
- Figueroa, J. J., Bott-Kitslaar, D. M., Mercado, J. A., Basford, J. R., Sandroni, P., Shen, W.-K., Sletten, D. M., Gehrking, T. L., Gehrking, J. A., Low, P. A., & Singer, W.
- Affiliations
- Mayo Clinic (US)
- Mayo Clinic in Arizona (US)
- Corresponding author
- Singer, Wolfgang
- Venue
- Autonomic Neuroscience
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 185
- Pages
- 107-111
- ISSN
- 1566-0702 (ISSN-L)
- PMC
- PMC4165658
- OpenAlex
- W2042110361
- Cited by
- 12
- References
- 5
- Citations by year
- 2025: 1 · 2024: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 2 · 2015: 1
- FWCI
- 0.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Autonomic Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K23NS075141, U54 NS065736)
- Mayo CTSA (UL1 TR000135)
- NIH Research Training Grant (T32 HD07447)
- Mayo Funds
- National Institute of Neurological Diseases and Stroke (NINDS) (U54 NS065736)
- NIH Office of Rare Diseases Research (ORDR)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, non-dipping blood pressure, plasma norepinephrine, autonomic neuropathy, sympathetic nervous system, 24-hour ambulatory blood pressure, sodium excretion, exercise oxygen consumption, sudomotor function
- MeSH terms
- Adult, Blood Pressure, Circadian Rhythm, Female, Heart Rate, Humans, Male, Norepinephrine, Posture, Retrospective Studies, Blood Pressure Monitoring, Ambulatory, Postural Orthostatic Tachycardia Syndrome
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