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Exercise Training Versus Propranolol in the Treatment of the Postural Orthostatic Tachycardia Syndrome
Hypertension, 07/21/2011
Clinical Article
Fu Q et al. – For patients with postural orthostatic tachycardia syndrome (POTS), exercise training is superior to propranolol at restoring upright hemodynamics, normalizing renal–adrenal responsiveness, and improving quality of life.
Methods- 19 patients (18 women and 1 man) completed a double-blind drug trial (propranolol or placebo) for 4 weeks, followed by 3 months of exercise training.
- 15 age-matched healthy individuals (14 women and 1 man) served as controls
- A 2-hour standing test was performed before and after drug treatment and training
- Hemodynamics, catecholamines, plasma renin activity, and aldosterone were measured supine and during 2-hour standing
- Authors found that both propranolol and training significantly lowered standing heart rate
- Standing cardiac output was lowered after propranolol treatment (P=0.01) but was minimally changed after training
- The aldosterone:renin ratio during 2-hour standing remained unchanged after propranolol treatment (4.1±1.7 [SD] before versus 3.9±2.0 after; P=0.46) but modestly increased after training (5.2±2.9 versus 6.5±3.0; P=0.05)
- Plasma catecholamines were not affected by propranolol or training
- Patient quality of life, assessed using the 36-item Short-Form Health Survey, was improved after training (physical functioning score 33±10 before versus 50±9 after; social functioning score 37±9 versus 48±6; both P<0.01) but not after propranolol treatment (34±10 versus 36±11, P=0.63; 39±7 versus 39±5, P=0.73)
