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Hyperadrenergic Postural Tachycardia Syndrome in Mast Cell Activation Disorders
Abstract
Postural tachycardia syndrome (POTS) is a disabling condition that commonly affects otherwise normal young females. Because these patients can present with a flushing disorder, we hypothesized that mast cell activation (MCA) can contribute to its pathogenesis. Here we describe POTS patients with MCA (MCA+POTS), diagnosed by episodes of flushing and abnormal increases in urine methylhistamine, and compared them to POTS patients with episodic flushing but normal urine methylhistamine and to normal healthy age-matched female controls. MCA+POTS patients were characterized by episodes of flushing, shortness of breath, headache, lightheadedness, excessive diuresis, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting. Triggering events include long-term standing, exercise, premenstrual cycle, meals, and sexual intercourse. In addition, patients were disabled by orthostatic intolerance and a characteristic hyperadrenergic response to posture, with orthostatic tachycardia (from 79±4 to 114±6 bpm), increased systolic blood pressure on standing (from 117±5 to 126±7 mm Hg versus no change in POTS controls), increased systolic blood pressure at the end of phase II of the Valsalva maneuver (157±12 versus 117±9 in normal controls and 119±7 mm Hg in POTS; P =0.048), and an exaggerated phase IV blood pressure overshoot (50±10 versus 17±3 mm Hg in normal controls; P <0.05). In conclusion, MCA should be considered in patients with POTS presenting with flushing. These patients often present with a typical hyperadrenergic response, but β-blockers should be used with great caution, if at all, and treatment directed against mast cell mediators may be required.
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In the citing paper
“Common comorbid conditions seen with POTS4,21 include hypermobile Ehlers–Danlos syndrome, mast cell activation syndrome,22 migraine and ME/CFS (Table 1).18”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [22]
In the citing paper
“Hyperadrenergic features can include tremulousness, anxiety, migraine and angina-like chest pain.22”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [22]
In the citing paper
“These episodes resemble those seen in patients with mast cell activation disorders (MCAD). Indeed, we have previously reported the association of MCAD and POTS in patients with a hyperadrenergic clinical phenotype responsive to central sympatholytics.12”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [12]
In the citing paper
“We and others have observed that these patients tend to have exaggerated pressor responses to the Valsalva maneuver (VM),12”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [12]
In the citing paper
“Clinically indistinguishable hyperadrenergic episodes were seen in POTS patients without MCAD12 and are also seen in patients with pseudopheochromocytoma.34,35”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [12]
In the citing paper
“We previously used methyldopa in the treatment of POTS associated with mast cell activation disorders that have a similar hyperadrenergic phenotype.12”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [12]
In the citing paper
“We have previously reported that spontaneous hyperadrenergic episodes with flushing, hypertension, and tachycardia are associated with MCAD in patients with POTS.12”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [12]
In the citing paper
“Treatments that improve symptoms of POTS might decrease the occurrence of syncope, although this is unknown (24,514–523).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [515]
In the citing paper
“An exaggerated sympathetic vasoconstrictor response during the Valsalva maneuver or the presence of orthostatic hypertension may suggest hyperadrenergic POTS (46).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [46]
In the citing paper
“Patients with MCAD may also demonstrate hyperadrenergic POTS features with testing, such as an exaggerated BP overshoot during recovery after the Valsalva maneuver (46).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [46]
In the citing paper
“Some patients with MCAD and associated POTS anecdotally responded to H 1 and H 2 histamine receptor blockers, the sympatholytic alphamethyldopa, or both (46).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [46]
In the citing paper
“Of note, in the same series, beta-blockers triggered episodes of worsening symptoms in several patients and should be used with caution if MCAD is suspected.”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [46]
In the citing paper
“Some POTS patients present with severe flushing in addition to their tachycardia and have an associated mast cell activation disorder.”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [56]
In the citing paper
“While many conditions, such as mast cell activation disorders (9), Ehlers-Danlos syndrome (10, 11), deconditioning (12), and genetic mutations of norepinephrine transporters (13), coexist with POTS, their downstream effects also funnel into these three principal pathophysiologic mechanisms.”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [9]
In the citing paper
“Mast cell activation disorders are another condition that frequently coexists with POTS (9).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [9]
In the citing paper
“Some POTS patients may present with flushing and orthostatic intolerance in the absence of mast cell activation disorder”
From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Shibao et al., 2005
In the citing paper
“a subgroup of POTS patients has been reported to present with episodic flushing and comorbid mast cell activation disorder”
From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Shibao et al., 2005
In the citing paper
“abnormal sympathetic activation may be related in some patients to the abnormal mast cell activation.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [57]
In the citing paper
“This specific subset of POTS is characterized by episodes of flushing, dyspnoea, headache, excessive diuresis and gastrointestinal symptoms such as diarrhoea, nausea and vomiting, accompanied by elevated urine methylhistamine [57].”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [57]
In the citing paper
“An alternative broader diagnostic scheme125 can lead to overdiagnosis of mast cell activation syndrome as has been described in case reports of POTS and hypermobile Ehlers-Danlos syndrome.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [125]
In the citing paper
“Exercise is an HRS Class IIA indication for POTS but remains a target of study49,50,125,170,173; its value in IST is unknown.49,50,125”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [125]
In the citing paper
“POTS is excessive sinus tachycardia triggered by minimal physical activity, especially movement to upright posture.36,50,125,171”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [125]
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“This finding highlights the need to differentiate this subgroup with associated mast cell activation from the larger group of patients with POTS who generally benefit from -blockers and on which antihistamines have no effect.(24) Respiratory symptoms are rarely predominant in patients with mast cell activation disorde…”
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“During one anecdotal study, six patients with POTS and concomitant mast cell activation disorder were contacted following 3 months treatment with anti-histamines and methyldopa, and a subjective clinical improvement in symptoms was documented.(56) These agents may cause drowsiness, dry mouth, or dizziness.”
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“Serum tryptase taken immediately after an episode of flushing or a 24-hour urinary N-methylhistamine level may provide some evidence of mast cell activation; however, this is uncommon.(5) Many patients go through a process of restricting their diet and/or food challenges for which standardized protocols may be used in…”
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“They can have hyperadrenergic postural tachycardia and are diagnosed by episodes of flushing and abnormal increases in urine methylhistamine and beta-blockers should be used with great caution, and treatment directed against mast cell mediators may be required [16].”
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“The associations of POTS with migraine headache, the hypermobile form of Ehlers-Danlos syndrome (hEDS) (De Wandele et al., 2014) and the hypermobility spectrum disorder, allergic disorders like mast cell activation syndrome (MCAS) (Shibao et al., 2005), and autoimmune disorders have been clearly described.”
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“compared 8 patients with POTS + MCAD (flushing episode with simultaneously increased urine methylhistamine levels) to 16 POTS patients with flushing but without MCAD, 5 patients with orthostatic hypotension + MCAD and to 12 healthy individuals [36].”
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Mast Cell Activation Disorder and Postural Orthostatic Tachycardia Syndrome: A Clinical Association
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Autoimmunity in Long Covid and POTS
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“[95] tested the hypothesis that plasma histamine can cause sympathetic overactivity via vasodilatation and compared POTS patients presenting flushing and raised urinary methylhistamine (a mast cell mediator metabolite) with patients reporting flushing but with normal urinary metabolites.”
BackgroundSympathoadrenal function in patients with paroxysmal hypertension: pseudopheochromocytoma
Sharabi, Y., Goldstein, D. S., Bentho, O., Saleem, A., Pechnik, S., Geraci, M. F., Holmes, C. S., Pacák, K., & Eisenhofer, G. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e3282ef5fac · Cited by 52
Theoharides, T. C., Twahir, A., & Kempuraj, D. (2023) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2023.10.032 · Cited by 58
Weinstock, L. B., Brook, J. B., Myers, T. L., & Goodman, B. P. (2018) · BMJ Case Reports · doi:10.1136/bcr-2017-221405 · Cited by 51
Quantitative assessment of autonomic symptom burden in Postural tachycardia syndrome (POTS)
Rea, N. A., Campbell, C. L., & Cortez, M. M. (2017) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2017.03.032 · Cited by 52
“Furthermore, the 3 items included in this domain do not assess flushing, a symptom potentially helpful in identification of cases associated with mast cell dysfunction (39).”
Mast Cell Activation Syndrome: Tools for Diagnosis and Differential Diagnosis
Weiler, C. R. (2019) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2019.08.022 · Cited by 46
Hamilton, M. J., Zhao, M., Giannetti, M. P., Weller, E., Hufdhi, R., Novak, P., Mendoza-Alvarez, L. B., Hornick, J., Lyons, J. J., Glover, S. C., et al. (2021) · American Journal of Surgical Pathology · doi:10.1097/pas.0000000000001676 · Cited by 44
Bonamichi-Santos, R., Yoshimi-Kanamori, K., Giavina-Bianchi, P., & Aun, M. V. (2018) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2018.04.004 · Cited by 42
“In 2005, Shibao and colleagues 26 described a group of patients with POTS who were also suffering from episodes of flushing, shortness of breath, headache, light-headedness, excessive diuresis, and gastrointestinal symptoms, such as diarrhea, nausea, and vomiting.”
Kanjwal, K., Saeed, B., Karabin, B., Kanjwal, Y., & Grubb, B. P. (2011) · Cardiology Journal · doi:10.5603/cj.2011.0008 · Cited by 46
“Beta-blockers and centrally acting sympatholytics like clonidine, by counteracting the excess norepinephrine either by decreasing the centrally mediated release or by receptor blockage, may result in a substantial decline in norepinephrine mediated effects [1, 2, 8, 15, 16].”
BackgroundSchofield, J. R., Blitshteyn, S., Shoenfeld, Y., & Hughes, G. (2014) · Lupus · doi:10.1177/0961203314524468 · Cited by 41
Mast cell activation syndrome: Current understanding and research needs
Castells, M., Giannetti, M. P., Hamilton, M. J., Novak, P., Pozdnyakova, O., Nicoloro-SantaBarbara, J., Jennings, S. V., Francomano, C., Kim, B., Glover, S. C., et al. (2024) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2024.05.025 · Cited by 45
Pediatric Postural Orthostatic Tachycardia Syndrome: Where We Stand
Boris, J. R., & Moak, J. P. (2022) · PEDIATRICS · doi:10.1542/peds.2021-054945 · Cited by 42
Autonomic Dysfunction in Cardiology: Pathophysiology, Investigation, and Management
Arnold, A. C., Ng, J., Lei, L. Y., & Raj, S. R. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.09.008 · Cited by 42
“Fifth, some patients have mast cell activation disorder (MCAD) in the absence of an overt trigger, and present with severe episodic flushing of the face or upper trunk and hyperadrenergic features.(52) Finally, norepinephrine transporter (NET) deficiency may contribute to POTS, by increasing synaptic norepinephrine le…”
Self-citationImmunology and clinical manifestations of non-clonal mast cell activation syndrome
Cardet, J.-C., Castells, M. C., & Hamilton, M. J. (2013) · Current Allergy and Asthma Reports · doi:10.1007/s11882-012-0326-8 · Cited by 39
Mast cell activation disease and the modern epidemic of chronic inflammatory disease
Afrin, L. B. (2016) · Translational Research · doi:10.1016/j.trsl.2016.01.003 · Cited by 39
“…found consistent with postural orthostatic tachycardia syndrome (POTS, particularly the hyperadrenergic variant, which has been associated with MCAS 358,359 ), but MCAS patients treated for POTS (eg, with midodrine or fludrocortisone) typically experience only modest improvement in their…”
Confounders of Vasovagal Syncope
Nwazue, V. C., & Raj, S. R. (2012) · Cardiology Clinics · doi:10.1016/j.ccl.2012.09.003 · Cited by 39
Self-citationPostural orthostatic tachycardia syndrome and the potential role of mast cell activation
Doherty, T. A., & White, A. A. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.05.001 · Cited by 37
Postural Orthostatic Tachycardia Syndrome (POTS): An Update for Clinical Practice
Sebastian, S. A., Co, E. L., Panthangi, V., Jain, E., Ishak, A., Shah, Y., Vasavada, A. M., & Padda, I. (2022) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2022.101384 · Cited by 41
Robertson, D. (2011) · Hypertension · doi:10.1161/hypertensionaha.110.163485 · Cited by 37
Clinical challenges in the diagnosis and management of postural tachycardia syndrome
Jones, P., Shaw, B., & Raj, S. (2016) · Practical Neurology · doi:10.1136/practneurol-2016-001405 · Cited by 34
Self-citationvan Campen, C. M. C., Rowe, P. C., & Visser, F. C. (2021) · Journal of Translational Medicine · doi:10.1186/s12967-021-02819-0 · Cited by 38
“However, alternative explanations for POTS include blood volume reduction [55], mast cell activation disorders [56], peripheral autonomic neuropathy [55, 57–61], high levels of norepinephrine while standing [62], and genetic abnormalities [63].”
BackgroundNonclonal Mast Cell Activation Syndrome
Hamilton, M. J. (2018) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2018.04.002 · Cited by 35
Kanjwal, K., Sheikh, M. A., Karabin, B. L., Kanjwal, Y., & Grubb, B. P. (2011) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2010.02994.x · Cited by 33
Long‐Term POTS Outcomes Survey: Diagnosis, Therapy, and Clinical Outcomes
Boris, J. R., Shadiack, E., McCormick, E. M., MacMullen, L. E., George‐Sankoh, I., & Falk, M. J. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.033485 · Cited by 36
Neuromuscular Strain Increases Symptom Intensity in Chronic Fatigue Syndrome
Rowe, P. C., Fontaine, K. R., Lauver, M., Jasion, S. E., Marden, C. L., Moni, M., Thompson, C. B., & Violand, R. L. (2016) · PLoS ONE · doi:10.1371/journal.pone.0159386 · Cited by 32
Defining Cardiac Dysautonomia – Different Types, Overlap Syndromes; Case-based Presentations
Lakkireddy, D. (2020) · Journal of Atrial Fibrillation · doi:10.4022/jafib.2403 · Cited by 33
Disautonomia: Uma Condição Esquecida – Parte 1
Rocha, E. A., Mehta, N., Távora‐Mehta, M. Z. P., Roncari, C. F., Cidrão, A. A. D. L., & Elías, J. (2021) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20200420 · Cited by 36
Evaluating and managing postural tachycardia syndrome
Lei, L. Y., Chew, D. S., Sheldon, R. S., & Raj, S. R. (2019) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.86a.18002 · Cited by 28
Self-citationPrevalence of joint hypermobility syndromes in pediatric postural orthostatic tachycardia syndrome
Boris, J. R., & Bernadzikowski, T. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2020.102770 · Cited by 27
Li, J., Zhang, Q., Hao, H.-J., Jin, H., & Du, J. (2014) · Chinese Medical Journal · doi:10.3760/cma.j.issn.0366-6999.20140244 · Cited by 26
Postural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management
Chen, G., Du, J., Jin, H., & Huang, Y. (2020) · Frontiers in Pediatrics · doi:10.3389/fped.2020.00474 · Cited by 27
“(82) found that some of them had flushing episodes associated with OI, which suggests that MCA is likely involved in the hyperadrenergic mechanism for POTS (82).”
BackgroundMechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome
Tu, Y., Abell, T. L., Raj, S. R., & Mar, P. L. (2020) · Neurogastroenterology & Motility · doi:10.1111/nmo.14031 · Cited by 27
Self-citationMoving from the present to the future of Postural Tachycardia Syndrome – What we need
Raj, S. R., & Robertson, D. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.06.007 · Cited by 22
Self-citationConfounders of Vasovagal Syncope
Nwazue, V. C., & Raj, S. R. (2013) · Cardiology Clinics · doi:10.1016/j.ccl.2012.09.004 · Cited by 23
Self-citationDizziness and Vertigo in the Adolescent
Taylor, J. W., & Goodkin, H. P. (2011) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2011.01.004 · Cited by 22
Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope
Raj, S. R., & Sheldon, R. S. (2016) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2016.7.2 · Cited by 24
Self-citationOrthostatic Circulatory Disorders: From Nosology to Nuts and Bolts
Gutkin, M. C., & Stewart, J. M. (2016) · American Journal of Hypertension · doi:10.1093/ajh/hpw023 · Cited by 20
Clinical neurophysiology of postural tachycardia syndrome
Cutsforth‐Gregory, J. K., & Sandroni, P. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64142-7.00066-7 · Cited by 22
Clinical features of hyperadrenergic postural tachycardia syndrome in children
Zhang, Q., Chen, X., Li, J., & Du, J. (2014) · Pediatrics International · doi:10.1111/ped.12392 · Cited by 20
Restless legs syndrome is associated with mast cell activation syndrome
Weinstock, L. B., Walters, A. S., Brook, J. B., Kaleem, Z., Afrin, L. B., & Molderings, G. J. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8216 · Cited by 19
“42,43 46 There is upregulation of hypoxia-inducible factor 1-alpha, vascular endothelial growth factor, and nitric oxide synthase in brains of patients with RLS compared to brains in control patients.”
Farley, M., Estrada-Mendizábal, R. J., Gansert, E. A., Voelker, D., Marks, L. A., & Gonzalez‐Estrada, A. (2025) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2025.03.022 · Cited by 18
Zhang, Q., Xu, B., & Du, J. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00525 · Cited by 20
“Hyperadrenergic POTS can be caused by norepinephrine transporter deficiency (36), pheochromocytoma, mast-cellactivation disorders (37), and baroreflex failure resulting from trauma to or irradiation of the neck.”
BackgroundVadas, P., Guzmán, J. C., McGillis, L., Mittal, N., & Walsh, S. R. (2020) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2020.08.015 · Cited by 18
Postural Orthostatic Tachycardia Syndrome (POTS)
Mizumaki, K. (2011) · Journal of Arrhythmia · doi:10.1016/s1880-4276(11)80031-1 · Cited by 19
Utility of Corrected QT Interval in Orthostatic Intolerance
Kim, J. B., Hong, S., Park, J., Cho, D., Park, K., & Kim, B. (2014) · PLoS ONE · doi:10.1371/journal.pone.0106417 · Cited by 18
“Various hypotheses, such as hypovolemia [37], venous pooling [38], hyperadrenergic states [39–41], and restricted adrenergic neuropathies [42] have been suggested to be possible mechanisms underlying POTS.”
BackgroundThe clinical features of hereditary alpha-tryptasemia
von Bubnoff, D., Koch, D., Stocker, H. R., Ludwig, R. J., Wortmann, F., & von Bubnoff, N. C. C. (2024) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.m2023.0287 · Cited by 17
Ruzieh, M., & Grubb, B. P. (2018) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-018-0563-1 · Cited by 18
“Worthy of note is the fact that β-blockers can trigger symptoms in patients with MCA [19].”
BackgroundInfluentialSmith, E. C., Diedrich, A., Raj, S. R., Gamboa, A., Shibao, C. A., Black, B. K., Peltier, A., Paranjape, S. Y., Biaggioni, I., & Okamoto, L. E. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.016196 · Cited by 16
Self-citation
Metadata
- Authors
- Shibao, C., Arzubiaga, C., Roberts, L. J., Raj, S., Black, B., Harris, P., & Biaggioni, I.
- Affiliations
- Vanderbilt University (US)
- Venue
- Hypertension
- Published
- 2005-03
- Volume
- 45
- Issue
- 3
- Pages
- 385-390
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2158298420
- Cited by
- 220
- References
- 24
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 15 · 2023: 9 · 2022: 18 · 2021: 13 · 2020: 23 · 2019: 9 · 2018: 21 · 2017: 20 · 2016: 10 · 2015: 5 · 2014: 8 · 2013: 6 · 2012: 7
- FWCI
- 5.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL67232, R01HL067232, HL56693, P01HL056693)
- National Center for Research Resources
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- postural orthostatic tachycardia syndrome, mast cell activation, flushing, orthostatic intolerance, Valsalva maneuver, beta-blocker therapy, mast cell mediators, pathogenesis
- MeSH terms
- Adrenergic beta-Antagonists, Adult, Autonomic Nervous System, Female, Histamine H1 Antagonists, Histamine H2 Antagonists, Humans, Hypotension, Orthostatic, Mast Cells, Methyldopa, Sympatholytics, Syndrome, Tachycardia, Case-Control Studies
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