The DOI matches its Crossref record; 27 of the 27 references it cites were found in a registry or an index; 4 of the 17 sources its claims cite were checked for support.
Propranolol Decreases Tachycardia and Improves Symptoms in the Postural Tachycardia Syndrome: Less Is More
Open accessAbstract
Background— Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate on standing. β-Blockade is an appealing treatment approach, but conflicting preliminary reports are conflicting. We tested the hypothesis that propranolol will attenuate the tachycardia and improve symptom burden in patients with POTS. In protocol 1, a low dose (20 mg) was compared with placebo, and the dose response was assessed in protocol 2. Methods and Results— In protocol 1, patients with POTS (n=54) underwent acute drug trials of propranolol 20 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, heart rate, and symptoms were assessed while the patients were seated and after standing for up to 10 minutes before and hourly after the study drug. Supine ( P <0.001) and standing ( P <0.001) heart rates were significantly lower after propranolol compared with placebo. The symptom burden improvement from baseline to 2 hours was greater with propranolol than placebo (median, −4.5 versus 0 arbitrary units; P =0.044). In protocol 2, 18 patients with POTS underwent similar trials of high-dose (80 mg) versus low-dose (20 mg) propranolol. Although the high dose elicited a greater decrease than the low dose in standing heart rate ( P <0.001) and orthostatic tachycardia ( P <0.001), the improvement in symptoms at 2 hours was greater with low-dose propranolol (−6 versus −2 arbitrary units; P =0.041). Conclusions— Low-dose oral propranolol significantly attenuated tachycardia and improved symptoms in POTS. Higher-dose propranolol did not further improve, and may worsen, symptoms.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
18 Own result · 11 Own method · 8 Own interpretation · 2 Sources not found · 2 No full text of the sources · 1 Supported · 1 Supported so far · 1 Partly supported · 1 Not checked yet · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Unfortunately, in experimental models of orthostatic intolerance, neither propranolol 15, 16 nor esmolol 17 were found to improve orthostatic tolerance.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [15]
- Not checked — no full text of the sourcecites [16] source
- Supportedcites [17] source
Citation 17 is attached to the esmolol finding, not the propranolol finding. The Abstract (page not supplied) states that esmolol did not improve orthostatic tolerance in patients with POTS tested during upright tilt; the Discussion likewise reports orthostatic intolerance during esmolol infusion. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Delta HR decreased in both groups, but significantly more at 1 hour following propranolol 20mg (16±11 min−1) than placebo (26±17 min−1; P=0.004), and remained significantly lower with propranolol at each hour during follow-up (the primary study endpoint was delta HR at 2 hours following study drug [P=0.033]).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Standing HR at 1-hour was lower with high dose (84±12 min−1) than low dose propranolol (93±15 min−1; P<0.001), and this significant difference persisted through the 4 hour follow-up.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #2: Comparison of Low-Dose Propranolol (20mg) vs. High Dose Propranolol (80mg)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By 2 hours post study drug, propranolol 20mg had significantly lowered seated SBP compared with placebo (98±11 mmHg vs. 107±15 mmHg; P=0.001; Fig 1e), and it remained significantly lower up to 4 hours post study drug.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although standing SBP following propranolol decreased for both low dose and high dose, this was significantly greater for the high dose (P<0.001).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #2: Comparison of Low-Dose Propranolol (20mg) vs. High Dose Propranolol (80mg)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seated HR at 1 hour decreased significantly with propranolol 20mg (84±14 min−1) compared with placebo (74±12 min−1; P<0.001), and remained significantly lower for the 4 hours of follow-up.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The primary endpoint in this protocol was delta HR at 2 hours following study drug (High Dose: 12±6 min−1 vs. Low Dose: 19±10 min−1;P<0.001).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #2: Comparison of Low-Dose Propranolol (20mg) vs. High Dose Propranolol (80mg)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By 1 hour post study drug, propranolol 20mg had significantly lowered the standing SBP compared with placebo (102±15 mmHg vs. 109±14 mmHg; P=0.009; Fig 1d), and it remained significantly lower for 3 hours post study drug.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The decrease in total symptom burden from baseline to 2 hours post study drug was significantly greater with propranolol 20mg than placebo (−4.5 [−14.5, 0] arbitrary units [au] vs. 0 [−3, 2] au; P=0.044; Fig 3a).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Symptoms
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Compared to placebo, propranolol 20mg effected a lower standing HR at 1 hour (90±13 min−1 vs. 110±18 min−1; P<0.001), and this difference was maintained at P<0.001 for the 4 hours following study drug administration.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 14
- It may state two separate claims as one. 16
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Many patients with POTS have increased sympathetic nervous system tone measured with direct nerve recordings 5 or biochemically with an elevated plasma norepinephrine on standing 6–8.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [5] source
- Supportedcites [6] source
The Abstract says patients with POTS often have an exaggerated rise in plasma norepinephrine on standing. Patient Characteristics reports a marked standing increase in the study participants. This supports the biochemical part of the citing sentence; the direct-nerve-recording part is attached to a different citation. (LLM, conf=0.93)
- Not matchedcites [7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites [8] sourceExperimental — accuracy not yet measured
The Results report elevated standing plasma norepinephrine in the proband, and the Discussion says central sympathetic tone seems increased in many patients with orthostatic intolerance. But the paper does not establish elevated standing norepinephrine as a measure of increased sympathetic outflow in many POTS patients; its clearance analysis shows that reduced norepinephrine removal contributed to the proband’s elevated level. The direct-nerve-recording portion is attached to a different citation in the citing sentence. (LLM, conf=0.85)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
Every source the paper cites for this claim was checked and supports it.
In the paper
“This symptom score has been previously used by our center 6 and the symptoms were chosen as they reflect common complaints of patients with POTS.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Symptoms
What the sources say
- Supportedcites [6] source
The Symptoms section states that the center had used the symptom score before and that its nine items were chosen because they reflect common complaints of patients with POTS. This directly supports the attributed claim. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“On standing, there was a marked increase in HR (Protocol#1: 122±26 min−1, P<0.001; Protocol #2: 130±29 min−1, P<0.001) and norepinephrine (Protocol#1: 4.94±3.35 nmol/l, P<0.001; Protocol#2: 3.93±2.21 nmol/l, P=0.015) compared with respective supine values.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Patient Characteristics
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, 3 symptoms (lightheadedness, mental clouding and shortness of breath) improved significantly only with low dose (20mg) propranolol, but not with high dose (80mg) propranolol.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Symptoms
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In protocol #1 (propranolol vs. placebo), 54 subjects with POTS had complete paired datasets suitable for analyses, as did 18 subjects in protocol #2 (propranolol 80 mg vs. propranolol 20 mg).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Patient Characteristics
plainn = 54- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“A most striking feature of this disorder is the excessive increase in heart rate (HR) that occurs upon standing in the absence of hypotension 4.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not matchedcites [4]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Beta-blockers have been reported to improve symptoms in case-reports 10, 11 and open-label studies 12, 13 and can decrease plasma norepinephrine levels in a hyperadrenergic state 14.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [10] source
- Not checked — no full text of the sourcecites [11] source
- Not checked — no full text of the sourcecites [12] source
- Not checked — no full text of the sourcecites [13] source
- Not matchedcites [14]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“POTS is associated with a very poor quality of life and significant functional disability 9; there are a paucity of effective therapies.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [9] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In protocol #2, a high dose (80 mg) was compared to a low dose (20 mg) of propranolol (Mylam Pharmaceuticals, Morgantown VW) in a randomized single-blind, cross-over fashion on separate days, with study endpoints as in protocol #1.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Drug Trials
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data reported are a part of “The Treatment of Orthostatic Intolerance” study, which is registered with www.ClinicalTrials.gov (NCT00262470).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Subjects
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“One reason for the limited effectiveness of beta-blockade might be that patients with POTS have a low stroke volume and might require an elevated HR in order to maintain their cardiac output 18.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [18] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In protocol #1, the patients with POTS were given a tablet of propranolol 20 mg (Mylam Pharmaceuticals, Morgantown VW) or placebo in a randomized single-blind, cross-over fashion on separate days.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Drug Trials
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These data suggest that while low doses of propranolol are of benefit in POTS, that higher doses might be counter-productive.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Conclusion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Another limitation of this study is the relatively small sample of patients in protocol #2, although it is comparable to other reported POTS trials.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our studies were conducted with the patient and the principal investigator blind to study drug order until after an individual’s study completion, but the research center nurse was not blind to the intervention. The study was thus single-blind, and not double-blind.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Low dose oral propranolol significantly attenuated tachycardia and improved symptoms in POTS.”
- Also stated in: § Conclusion · boosted
“We have found that low dose propranolol is a highly effective agent in acutely decreasing the orthostatic tachycardia and improving symptoms in patients with POTS.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > Abstract > Conclusions
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
- Also stated in: § Conclusion · boosted
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Since there is no objective anchor to these symptoms, one individual’s rating may vary greatly from that of another individual (e.g. one person’s rating of 4 may reflect more severe symptoms than another person’s rating of 6).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Vanderbilt POTS Symptom Score
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This is one reason that all of our symptom-based analyses were done using paired comparisons within an individual.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Vanderbilt POTS Symptom Score
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In fact, the relationship between propranolol dose and symptoms is more complicated. Some individual symptoms did improve with high dose propranolol (such as palpitation and tremulousness; see Table 4), while other symptoms did not improve (lightheadedness, mental clouding, and shortness of breath).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Less is More: Benefits of Low Dose Propranolol
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Higher dose propranolol did not further improve, and may worsen, symptoms.”
- Also stated in: § Conclusion · hedged
“Symptoms did not further improve with higher doses of propranolol, suggesting that caution should be used by clinicians in titrating up the propranolol dose.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > Abstract > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
- Also stated in: § Conclusion · hedged
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The higher dose of propranolol did further restrain orthostatic tachycardia in the patients with POTS, but there was no further improvement in symptoms.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Less is More: Benefits of Low Dose Propranolol
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is noteworthy, however, that the research center nurse did not directly collect the data presented in this report. The hemodynamic data were collected by an automated oscillometric BP cuff that was connected to a personal computer for digital data collection, and the symptoms were all self-reported by the blinded patient.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
The study is the first placebo-controlled trial of a beta-blocker in POTS.
“This paper is the first placebo controlled trial of a beta-blocker in patients with POTS.”
“These are the first blinded data comparing oral beta-blocker therapy to placebo in POTS.”
The paper relies on this without support.
Repeated symptom ratings from the same patient use a relatively stable frame of reference.
“Like serial chest pain rating scales, however, we expect serial intrapatient reports to use a more constant frame of reference.”
The paper relies on this without support.
Standing from a seated position gives a clinically relevant and reproducible orthostatic stress.
“While conducting the study while seated might decrease the magnitude of the orthostatic tachycardia, it does provide a clinically relevant and reproducible scenario.”
The paper relies on this without support.
The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
“This symptom score has been previously used by our center 6 and the symptoms were chosen as they reflect common complaints of patients with POTS.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“low-dose propranolol (10–20 mg PO) acutely lowers standing heart rate and improves symptoms in patients with POTS, while higher doses of propranolol are less well tolerated.42”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [42]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Propranolol is a nonselective beta-blocker that has been shown to mitigate tachycardia and symptoms in patients with POTS, but may have off-target side effects due to the broad distribution of beta-adrenergic receptors throughout the body.6, 7, 8”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Beta-blockers, specifically propranolol, have been shown, in low doses, to improve orthostatic tachycardia and reduce norepinephrine levels in these patients.6”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This orthostatic tachycardia is due to sympathetic activation, given that it is associated with a significant elevation in plasma norepinephrine and is blunted by even low doses of beta-blockers.2”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [2]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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 [520]
Experimental — accuracy not yet measured
The cited source says what the claim attributes to it.
In the citing paper
“Both ivabradine and propranolol significantly reduced the orthostatic HR increase compared to placebo, consistent with earlier studies.4,6,28”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“A limited number of prior studies have examined the effects of propranolol or ivabradine on POTS.4,6,9, 10, 11, 12”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“Propranolol is a nonselective beta-blocker that has been shown to mitigate tachycardia and symptoms in patients with POTS, but may have off-target side effects due to the broad distribution of beta-adrenergic receptors throughout the body.6, 7, 8”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“A 2009 randomized crossover study found that low-dose oral propranolol improved tachycardia and symptoms on standing,45”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [45]
In the citing paper
“The non-selective β-AR antagonist propranolol acutely restrains orthostatic tachycardia and symptoms at doses that appear to be low enough (10-20 mg) to avoid the side effect of significant fatigue [64].”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [64]
In the citing paper
“Raj et al. (78) demonstrated that the use of propranolol (instant release) at a 20 mg dose significantly reduced orthostatic tachycardia, and improved symptoms compared to placebo up to 4 h after administration.”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [78]
In the citing paper
“Properly dosed exercise training can be an effective non-pharmacologic therapeutic intervention for reversing severe muscle disuse atrophy and restoring normal exercise cardiac rate and rhythm caused by a continuous period of bedrest in otherwise healthy adults192–194.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [193]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > Abstract > Methods and Results
“Supine (P<0.001) and standing (P<0.001) HR were significantly lower following propranolol compared to placebo.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Drug Trials
“The patients were seated comfortably in a chair for the duration of the data collection except during the prescribed periods of standing.”
Citations
Cites
A Comparative Review of Generic Quality-of-Life Instruments
Coons, S. J., Rao, S. R., Keininger, D. L., & Hays, R. D. (2000) · PharmacoEconomics · doi:10.2165/00019053-200017010-00002 · Cited by 834
Orthostatic Intolerance and Tachycardia Associated with Norepinephrine-Transporter Deficiency
Shannon, J. R., Flattem, N. L., Jordan, J., Jacob, G., Black, B. K., Biaggioni, I., Blakely, R. D., & Robertson, D. (2000) · New England Journal of Medicine · doi:10.1056/nejm200002243420803 · Cited by 594
Self-citationPostural tachycardia syndrome (POTS)
Lamotte, G., & Low, P. A. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85492-4.00118-6 · Cited by 301
Raj, S. R., Biaggioni, I., Yamhure, P. C., Black, B. K., Paranjape, S. Y., Byrne, D. W., & Robertson, D. (2005) · Circulation · doi:10.1161/01.cir.0000160356.97313.5d · Cited by 286
Self-citationQuality of Life in Patients With Postural Tachycardia Syndrome
Benrud-Larson, L. M., Dewar, M. S., Sandroni, P., Rummans, T. A., Haythornthwaite, J. A., & Low, P. A. (2002) · Mayo Clinic Proceedings · doi:10.4065/77.6.531 · Cited by 217
(2006) · PubMed · Cited by 190
Self-citationAcetylcholinesterase inhibition improves tachycardia in postural tachycardia syndrome
Raj, S. R., Black, B. K., Biaggioni, I., Harris, P. A., & Robertson, D. (2005) · Circulation · doi:10.1161/circulationaha.104.497594 · Cited by 171
Self-citationHypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system
Jacob, G., Robertson, D., Mosqueda-Garcia, R., Ertl, A. C., Robertson, R. M., & Biaggioni, I. (1997) · The American Journal of Medicine · doi:10.1016/s0002-9343(97)00133-2 · Cited by 164
Self-citationChronic orthostatic intolerance and the postural tachycardia syndrome (POTS)
Stewart, J. M. (2004) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2004.06.084 · Cited by 116 · cited 1×
“atic improvement; (2) higher-dose propranolol (more com-”
Schrezenmaier, C., Gehrking, J. A., Hines, S. M., Low, P. A., Benrud‐Larson, L. M., & Sandroni, P. (2005) · Mayo Clinic Proceedings · doi:10.4065/80.3.330 · Cited by 108
Research works printed but not linked: 1
- 10.1161/hyp.38.6.1377 · DOI
Cited by
Sorted by citations
Items 201–224 of 224
Sinus Tachycardias: Inappropriate Sinus Tachycardia and Postural Tachycardia Syndrome
Shaw, B. H., Ng, J., & Raj, S. R. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809657-4.99799-0
Self-citationCirculation: Arrhythmia and Electrophysiology Editors' Picks
Editors, T. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.968941
Miwa, K. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4132922
Dysautonomia and Atopy in Pediatric Headache Patients
Feldman, D., & Williams, R. P. (2022) · Springer eBooks · doi:10.1007/978-3-031-13931-4_8
Emergence of the sequels under the COVID-19 epidemic
Xia, Z. (2023) · Highlights in Science Engineering and Technology · doi:10.54097/hset.v36i.6191
Kamath, V., Anand, R., Radhakrishnan, B., & Markanday, K. (2022) · APIK Journal of Internal Medicine · doi:10.4103/ajim.ajim_119_21
Ertürk, E., Ocak, K., Uyan, U., Çoner, A., Kocabaş, U., Kış, M., Başkurt, A. A., Oray, D., Sayın, B. Y., Mammadov, G., et al. (2023) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.2688
Letourneau-Shesaf, S., & Raj, S. R. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95082-4.00024-4
Self-citationFeeling shaky with palpitations
Grubb, B. P. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95082-4.00018-9
Overview of Postural Orthostatic Tachycardia Syndrome (POTS) for General Cardiologists
Nassereddin, A., Kramer, E. F., Fedorowski, A., & Ruzieh, M. (2024) · Cardiovascular Innovations and Applications · doi:10.15212/cvia.2023.0098 · Cited by 1
In memoriam: a celebration of the autonomic contributions of David Robertson (1947–2024)
Biaggioni, I., Arnold, A. C., Black, B. K., Diedrich, A., Furlan, R., Gamboa, A. C., Garland, E. M., Jacob, G., Jordan, J., Okamoto, L. E., et al. (2024) · Clinical Autonomic Research · doi:10.1007/s10286-024-01025-4
Self-citationKatwaroo, A. R., Chandolu, K. M., Seecheran, V. K., Ramcharan, P., Seecheran, R. V., Giddings, S., Bhagwandass, N., & Seecheran, N. A. (2024) · Cureus · doi:10.7759/cureus.64008
“In addition, it has been shown that a non-selective beta-blocker may be more effective than a selective beta-blocker since it also blocks beta-2 adrenoreceptor-mediated vasodilation [22,24].”
BackgroundSinus Tachycardias: Inappropriate Sinus Tachycardia and Postural Orthostatic Tachycardia Syndrome
Talati, A., Uppal, J., Sheldon, R. S., & Raj, S. R. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15734-9.00016-9
Self-citationSyndrome de tachycardie posturale orthostatique
Seder, E., Deharo, J., & Maillé, B. (2023) · EMC - Cardiologie · doi:10.1016/s1166-4568(22)41769-4
10.1016/b978-84-8086-956-0.00094-0
(2000) · Time to knit · doi:10.1016/b978-84-8086-956-0.00094-0
Structural Cardiovascular and Pulmonary Dysfunction and hEDS/HSD
DePace, N. L., Soloway, S., Yayac, M. F., & Colombo, J. (2025) · Springer eBooks · doi:10.1007/978-3-031-88769-7_11
Exercise for Postural Orthostatic Tachycardia Syndrome: Challenges and Opportunities to Improve
Rasnake, E. B., Kouvel, K., Cooper, S., & Greenberg, E. M. (2025) · Cardiopulmonary Physical Therapy Journal · doi:10.1097/cpt.0000000000000304 · Cited by 1
Chaudhury, D., Atia, N., Obiechina, N., Gill, A., Michael, A., & Sampathy, K. (2025) · Cureus · doi:10.7759/cureus.97581
“Beta-adrenergic antagonists like bisoprolol and low-dose propranolol control the tachycardia and often provide symptomatic relief in POTS [22].”
Ishii, W. (2026) · Journal of Nihon University Medical Association · doi:10.4264/numa.85.2_51
Too high and too loose: dysautonomia and the hypertensive paradox in hypermobility disorders
Johnson, J. W., Mirro, I., & Kontorovich, A. (2026) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000001310 · Cited by 1
Yu, Y., Fan, Y., Ren, L., & Cao, L. (2026) · Blood Pressure · doi:10.1080/08037051.2026.2719281
Postural Orthostatic Tachycardia Syndrome (POTS)
Chung, T., & Raj, S. R. (2026) · JAMA · doi:10.1001/jama.2026.14809
Self-citationMureşan, L., Cismaru, G., Popa, S., Roşu, R., Guşetu, G., Puiu, M., Mada, R. O., Muresan, C., Bouar, R. L., Schiau, S., et al. (2026) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-026-00828-2
Metadata
- Authors
- Raj, S. R., Black, B. K., Biaggioni, I., Paranjape, S. Y., Ramirez, M., Dupont, W. D., & Robertson, D.
- Affiliations
- Vanderbilt University (US)
- Venue
- Circulation
- Published
- 2009-09
- Volume
- 120
- Issue
- 9
- Pages
- 725-734
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC2758650
- OpenAlex
- W2145724863
- Cited by
- 225
- References
- 27
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 16 · 2023: 15 · 2022: 20 · 2021: 18 · 2020: 13 · 2019: 10 · 2018: 16 · 2017: 13 · 2016: 9 · 2015: 8 · 2014: 9 · 2013: 14 · 2012: 15
- FWCI
- 13.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL071784, P01HL056693)
- National Institute of Neurological Disorders and Stroke (R01NS055670)
- National Center for Research Resources (M01RR000095, UL1RR024975, K23RR020783)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, propranolol, beta-blockers, orthostatic intolerance, heart rate, symptom burden, dose-response relationship
- MeSH terms
- Administration, Oral, Adrenergic beta-Antagonists, Adult, Blood Pressure, Dose-Response Relationship, Drug, Female, Heart Rate, Humans, Male, Placebos, Propranolol, Sympathetic Nervous System, Tachycardia, Treatment Outcome, Cross-Over Studies, Postural Orthostatic Tachycardia Syndrome, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
