Efficacy of Therapies for Postural Tachycardia Syndrome: A Systematic Review and Meta-analysis
Abstract
Objective To identify the evidence base and evaluate the efficacy of each treatment for postural tachycardia syndrome (POTS) in light of a recent consensus statement highlighting the lack of treatment options with clear benefit to risk ratios for this debilitating condition.Methods The CENTRAL (Cochrane Central Register of Controlled Trials), PubMed, and Embase databases from inception to May 2017 were searched using the terms postural AND tachycardia AND syndrome. A total of 135 full-text publications were screened after excluding duplicates (n=681), conference abstracts (n=467), and records that did not relate to POTS therapy (n=876). We included 28 studies with at least 4 patients with POTS in which symptomatic response was reported after more than 4 weeks of therapy. This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Two investigators independently performed the data extraction and evaluated the quality of evidence.Results This study comprised 25 case series and 3 small randomized controlled trials that evaluated 755 and 103 patients with POTS, respectively. Interventions directed at increasing intravascular volume, increasing peripheral or splanchnic vascular tone, controlling heart rate, and increasing exercise tolerance demonstrate moderate efficacy (range, 51%-72%). Few data exist on their comparative effectiveness. Significant heterogeneities were seen in terms of patient age, symptom severity, and the measures used to evaluate treatment efficacy.Conclusion The current evidence base to guide optimal management of patients with POTS is extremely limited. More high-quality collaborative research with standardized reporting of symptom response and treatment tolerability is urgently needed.
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Large randomized trials in POTS are not available.
“It should be kept in mind, however, that large randomized trials are not available [71]”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [71]
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Self-citation
- Authors
- Wells, R., Elliott, A. D., Mahajan, R., Page, A., Iodice, V., Sanders, P., & Lau, D. H.
- Affiliations
- Royal Adelaide Hospital (AU)
- South Australian Health and Medical Research Institute (AU)
- National Hospital for Neurology and Neurosurgery (GB)
- Corresponding author
- Lau, Dennis H.
- ORCID
- Venue
- Mayo Clinic Proceedings
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 93
- Issue
- 8
- Pages
- 1043-1053
- ISSN
- 0025-6196 (ISSN-L)
- OpenAlex
- W2809342281
- Cited by
- 67
- References
- 54
- Citations by year
- 2026: 12 · 2025: 8 · 2024: 11 · 2023: 11 · 2022: 4 · 2021: 5 · 2020: 12 · 2019: 3 · 2018: 1
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Mayo Clinic Proceedings (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- 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, intravascular volume expansion, peripheral vascular tone, rate control, exercise tolerance, treatment tolerability, symptom response, comparative effectiveness
- MeSH terms
- Adrenergic beta-Antagonists, Blood Volume, Erythropoietin, Heart Rate, Humans, Vasoconstrictor Agents, Exercise, Exercise Tolerance, Dopamine Uptake Inhibitors, Postural Orthostatic Tachycardia Syndrome
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