Outcomes in Adolescents with Postural Orthostatic Tachycardia Syndrome Treated with Midodrine and β‐Blockers
Abstract
Background Postural orthostatic tachycardia syndrome (POTS) is associated with debilitating fatigue, dizziness, and discomfort in previously healthy adolescents. The effects of medical therapy have not been well studied in this patient population. This study assessed the relative efficacy and impact of drug therapy on the functioning and quality of life in adolescents with POTS. Methods A retrospective, single center, chart review analysis with a follow-up written survey was conducted on a group of 121 adolescents who had undergone autonomic reflex screening at the Mayo Clinic from 2002 to 2005 as part of an evaluation for possible POTS. Results Of 121 surveys sent, 47 adolescents returned a completed survey. In this cohort of patients, the two most commonly prescribed drug therapies were midodrine (n = 13) and beta-blockers (n = 14). Patients in the midodrine group were comparable to patients in the beta-blocker group in gender, age, pretreatment postural heart rate changes, and months from initial evaluation to survey completion. More patients treated with a beta-blocker reported improvement after visiting Mayo Clinic (100% vs 62%, P = 0.016) and more attributed their progress to medication (63.6% vs 36.4%, P = 0.011) than did those treated with midodrine. Conclusion Treatment with both midodrine and beta-blockers was associated with overall improvement in POTS patients' general health; however, adolescents taking beta-blockers were more likely than those taking midodrine t…
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Midodrine is used to promote venoconstriction and vasoconstriction in POTS patients and has shown benefit in small studies.
“Midodrine, an oral alpha-adrenoceptor agonist prodrug, is used to promote venoconstriction and vasoconstriction in POTS patients and has shown benefit in small studies (Lai et al., 2009; Zhang et al., 2012).”
From Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 (2021) · cites this paper as Lai et al., 2009
About 60% of adolescent POTS patients in a Mayo Clinic study reported general health improvement at a mean of approximately 20 months after initial evaluation and treatment with midodrine and β-blockers.
“In one study from the Mayo Clinic, about 60% of adolescent POTS patients reported general improvement in health at an approximate mean of 20 months following initial evaluation and treatment with medications such as midodrine and β-blockers (Lai et al., 2009).”
From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Lai et al., 2009
Midodrine is a direct alpha1-adrenoreceptor agonist.
“Direct a1-adrenoreceptor agonist.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [82]
Midodrine may be effective in POTS patients with the hypovolaemic subtype and a low-blood-pressure phenotype with pronounced orthostatic intolerance.
“It may be effective in 'hypovolaemic' subtype and low-BP phenotype with pronounced orthostatic intolerance.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [82]
Midodrine is one of the few pharmacological agents positively tested in placebo-controlled studies for orthostatic hypotension.
“One of the few pharmacological agents positively tested in placebo-controlled studies for orthostatic hypotension.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [82]
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- Authors
- LAI, C. C., FISCHER, P. R., BRANDS, C. K., FISHER, J. L., PORTER, C. J., DRISCOLL, S. W., & GRANER, K. K.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- FISCHER, PHILIP R.
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 2009-01-23
- Volume
- 32
- Issue
- 2
- Pages
- 234-238
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W2045755315
- Cited by
- 70
- References
- 7
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 10 · 2019: 4 · 2018: 7 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 8 · 2013: 5 · 2012: 2
- FWCI
- 4.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- 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, adolescents, midodrine, beta-blockers, autonomic dysfunction, quality of life, treatment outcomes
- MeSH terms
- Adolescent, Adrenergic beta-Antagonists, Drug Therapy, Combination, Female, Humans, Male, Midodrine, Vasoconstrictor Agents, Treatment Outcome, Postural Orthostatic Tachycardia Syndrome
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