Splanchnic venous compression enhances the effects of ß-blockade in the treatment of postural tachycardia syndrome
Open accessAbstract
Background: Splanchnic venous pooling induced by upright posture triggers a compensatory increase in heart rate ( HR ), a response that is exaggerated in patients with postural tachycardia syndrome. To assess whether abdominal compression attenuates orthostatic tachycardia and improves symptoms, 18 postural tachycardia syndrome patients (32±2 years) were randomized to receive either abdominal compression (40 mm Hg applied with an inflatable binder ≈2 minutes before standing) or propranolol (20 mg) in a placebo‐controlled, crossover study. Methods and Results: Systolic blood pressure, HR , and symptoms were assessed while seated and standing, before and 2 hours postdrug. As expected, propranolol decreased standing HR compared with placebo (81±2 versus 98±4 beats per minute; P <0.001) and was associated with lower standing systolic blood pressure (93±2 versus 100±2 mm Hg for placebo; P =0.002). Compression had no effect on standing HR (96±4 beats per minute) but increased standing systolic blood pressure compared with placebo and propranolol (106±2 mm Hg; P <0.01). Neither propranolol nor compression improved symptoms compared with placebo. In 16 patients we compared the combination of abdominal compression and propranolol with propranolol alone. The combination had no additional effect on standing HR (81±2 beats per minute for both interventions) but prevented the decrease in standing systolic blood pressure produced by propranolol (98±2 versus 93±2 mm Hg for propranolol; P =0.029), and significantly improved total symptom burden (−6±2 versus −1±2 for propranolol; P =0.041). Conclusions: Splanchnic venous compression alone did not improve HR or symptoms but prevented the blood pressure decrease produced by propranolol. The combination was more effective in improving symptoms than either alone. Splanchnic venous compression can be a useful adjuvant therapy to propranolol in postural tachycardia syndrome. Registration: URL : https://www.clinicaltrials.gov ; Unique identifier: NCT 00262470.
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All three randomized experimental crossover trials of compression were associated with a significant treatment effect on symptom burden relative to comparison conditions.
“All three trials were associated with a significant treatment effect on symptom burden relative to the comparison conditions.”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Smith et al., 2020
The Results (Primary Objective) report no significant difference in symptom-burden changes among placebo, abdominal compression, and propranolol (P=0.477). The Results (Secondary Objective) report a significant improvement only for compression combined with propranolol versus propranolol alone (P=0.041), contrary to the claim that all three comparisons showed a significant effect. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredIn the trial combining splanchnic venous compression and propranolol, splanchnic venous compression prevented the blood pressure decrease produced by propranolol.
“it did prevent the blood pressure decrease produced by propranolol”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Smith et al., 2020
In the trial combining splanchnic venous compression and propranolol, splanchnic venous compression alone did not improve symptom burden.
“splanchnic venous compression alone did not improve symptom burden”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Smith et al., 2020
The combination of splanchnic venous compression and propranolol was more effective in improving symptoms than either alone.
“therefore the combination was more effective in improving symptoms than either alone (Smith et al., 2020”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Smith et al., 2020
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“…trial Raj et al., 2005 ++++++++ + ++++++ ++++++ +++ Proof-of-concept trial Raj et al., 2009 ++++++++ + +++++++ +++++ +++ Proof-of-concept trial Smith et al., 2020 ++++++++++ + ++++++ +++++ +++ Proof-of-concept trial Jo ur na l P re -p ro of For POTS, the weighted pooled average COMPASS-31…”
Influential
- Authors
- Smith, 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.
- Affiliations
- Vanderbilt University (US)
- University of Calgary (CA)
- Corresponding author
- Okamoto, Luis E.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2020-07-21
- Volume
- 9
- Issue
- 14
- Pages
- e016196-e016196
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC7660715
- OpenAlex
- W3042843506
- Cited by
- 16
- References
- 17
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 3 · 2022: 3 · 2021: 3 · 2020: 1
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000445)
- National Heart, Lung, and Blood Institute (R01HL142583, R01HL144568, P01HL056693, R01HL149386, R01HL122847)
- National Institute of Neurological Disorders and Stroke (U54NS065736)
- National Center for Research Resources (KL2RR024977)
- National Center for Advancing Translational Sciences
- 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, abdominal compression, propranolol, beta-adrenergic blockade, orthostatic tachycardia, heart rate, systolic blood pressure, symptom burden, adjuvant therapy
- MeSH terms
- Adrenergic beta-Antagonists, Adult, Blood Pressure, Female, Heart Rate, Humans, Propranolol, Splanchnic Circulation, Cross-Over Studies, Postural Orthostatic Tachycardia Syndrome, Compression Bandages
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