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Cited by 77Cardiovascular Syncope and Autonomic DisordersRenin-Angiotensin System StudiesHeart Rate Variability and Autonomic Control

Increased plasma angiotensin II in postural tachycardia syndrome (POTS) is related to reduced blood flow and blood volume

Open access
Stewart, Julian M., Glover, June L., Medow, Marvin S.·2006·Clinical Science
DOI 10.1042/cs20050254PMC PMC4511483
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Abstract

POTS (postural tachycardia syndrome) is associated with low blood volume and reduced renin and aldosterone; however, the role of Ang (angiotensin) II has not been investigated. Previous studies have suggested that a subset of POTS patients with increased vasoconstriction related to decreased bioavailable NO (nitric oxide) have decreased blood volume. Ang II reduces bioavailable NO and is integral to the renin-Ang system. Thus, in the present study, we investigated the relationship between blood volume, Ang II, renin, aldosterone and peripheral blood flow in POTS patients. POTS was diagnosed by 70 degrees upright tilt, and supine calf blood flow, measured by venous occlusion plethysmography, was used to subgroup POTS patients. A total of 23 POTS patients were partitioned; ten with low blood flow, eight with normal flow and five with high flow. There were ten healthy volunteers. Blood volume was measured by dye dilution. All biochemical measurements were performed whilst supine. Blood volume was decreased in low-flow POTS (2.14 +/- 0.12 litres/m2) compared with controls (2.76 +/- 0.20 litres/m2), but not in the other subgroups. PRA (plasma renin activity) was decreased in low-flow POTS compared with controls (0.49 +/- 0.12 compared with 0.90 +/- 0.18 ng of Ang I.ml(-1).h(-1) respectively), whereas plasma Ang II was increased (89 +/- 20 compared with 32 +/- 4 ng/l), but not in the other subgroups. PRA correlated with aldosterone (r = +0.71) in all subjects. PRA correlated negati…

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  • A perturbed renin-angiotensin-aldosterone axis leading to low blood volume is a potential mechanism that contributes to POTS pathophysiology.

    “These studies strongly implicate a perturbed RAAS axis leading to low blood volume as a potential mechanism that contributes to POTS pathophysiology.”

    From Gynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome (2012) · cites this paper as [25]

  • Patients with POTS have paradoxically low aldosterone levels, inappropriately low plasma renin activity, and elevated concentrations of circulating angiotensin II despite low blood volume.

    “Despite their low blood volume, patients with POTS were found to have paradoxically low aldosterone levels and inappropriately low plasma renin activity, while having elevated concentrations of circulating angiotensin II [12,25].”

    From Gynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome (2012) · cites this paper as [25]

  • Circulating angiotensin II levels are reported elevated in POTS without a parallel increase in its metabolite angiotensin (1-7).

    “Circulating angiotensin II levels have been reported to be elevated but without a parallel increase in its metabolite angiotensin (1-7) [50;51].”

    From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [51]

  • These paradoxical findings suggest that POTS patients might have decreased angiotensin II metabolism and that dysregulation by the renin-angiotensin-aldosterone system might contribute to hypovolemia in POTS.

    “These paradoxical findings suggest that POTS patients might have decreased angiotensin II metabolism and that dysregulation by the renin-angiotensin-aldosterone system might contribute to hypovolemia in POTS [50;51].”

    From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [51]

  • Plasma angiotensin 2 levels in some POTS patients are elevated on the order of 2-3 times higher than healthy controls.

    “Further investigations into the renin-angiotensin aldosterone system (RAAS) revealed that plasma angiotensin 2 (Ang-II) levels in some POTS patients are elevated (on the order of 2-3 times higher) when compared to healthy controls (35, 36).”

    From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [35]

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Authors
Stewart, J. M., Glover, J. L., & Medow, M. S.
Affiliations
New York Medical College (US)
ORCID
Venue
Clinical Science
Publisher
Portland Press Ltd.
Published
2006-01-17
Volume
110
Issue
2
Pages
255-263
ISSN
  • 0143-5221 (ISSN-L)
  • 1470-8736
DOI
10.1042/cs20050254
PMC
PMC4511483
OpenAlex
W2001948080
Cited by
77
References
54
Citations by year
2026: 2 · 2025: 3 · 2024: 7 · 2023: 10 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 7 · 2017: 4 · 2016: 2 · 2015: 3 · 2014: 3 · 2013: 2 · 2012: 4
FWCI
4.08
Type
journal article
Language
en
Open access
Locations
  • Clinical Science (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Wake Forest University
  • National Institutes of Health
  • Wake Forest School of Medicine
  • National Heart, Lung, and Blood Institute (R01HL066007, 1R01 HL66007, R01HL074873)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
postural orthostatic tachycardia syndrome, angiotensin II, plasma renin activity, aldosterone, blood volume, peripheral blood flow, calf blood flow, renin-angiotensin system, nitric oxide bioavailability, vasoconstriction, venous occlusion plethysmography
MeSH terms
Adolescent, Adult, Aldosterone, Analysis of Variance, Angiotensin II, Blood Volume, Female, Humans, Hypotension, Orthostatic, Leg, Male, Plethysmography, Posture, Regional Blood Flow, Renin, Tachycardia, Vascular Resistance, Case-Control Studies, Tilt-Table Test, Hypovolemia

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