TY - JOUR
T1 - Decreased orthostatic adrenergic reactivity in non-dipping postural tachycardia syndrome
AU - Figueroa, Juan J.
AU - Bott-Kitslaar, Darlene M.
AU - Mercado, Joaquin A.
AU - Basford, Jeffrey R.
AU - Sandroni, Paola
AU - Shen, Win Kuang
AU - Sletten, David M.
AU - Gehrking, Tonette L.
AU - Gehrking, Jade A.
AU - Low, Phillip A.
AU - Singer, Wolfgang
N1 - Funding Information:
The Autonomic Diseases Consortium is a part of the NIH Rare Diseases Clinical Research Network (RDCRN). Funding and/or programmatic support for this project has been provided by U54 NS065736 from the National Institute of Neurological Diseases and Stroke (NINDS) and the NIH Office of Rare Diseases Research (ORDR) .
Funding Information:
This investigation was supported in part by National Institutes of Health [NS 32352 Autonomic Disorders Program Project, K23NS075141 , NS 44233 Pathogenesis and Diagnosis of Multiple System Atrophy, U54 NS065736 Autonomic Rare Disease Clinical Consortium], Mayo CTSA [ UL1 TR000135 ], NIH Research Training Grant under Ruth L. Kirschstein National Research Service Award T32 HD07447 , and Mayo Funds .
Publisher Copyright:
© 2014 Elsevier B.V.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Whether non-dipping - the loss of the physiologic nocturnal drop in blood pressure - among patients with postural tachycardia syndrome (POTS) is secondary to autonomic neuropathy, a hyperadrenergic state, or other factors remains to be determined. In 51 patients with POTS (44 females), we retrospectively analyzed 24-hour ambulatory blood pressure recordings, laboratory indices of autonomic function, orthostatic norepinephrine response, 24-hour natriuresis and peak exercise oxygen consumption. Non-dipping (<. 10% day-night drop in systolic blood pressure) was found in 55% (n= 28). Dippers and non-dippers did not differ in: 1) baseline characteristics including demographic and clinical profile, sleep duration, daytime blood pressure, 24-hour natriuresis, and peak exercise oxygen consumption; 2) severity of laboratory autonomic deficits (sudomotor, cardiovagal and adrenergic); 3) frequency of autonomic neuropathy (7/23 vs. 8/28, P= 0.885); 4) supine resting heart rate (75.3 ± 14.0. bpm vs. 74.0 ± 13.8. bpm, P= 0.532); or 5) supine plasma norepinephrine level (250.0 ± 94.9. pg/ml vs. 207.0 ± 86.8. pg/ml, P= 0.08). However, dippers differed significantly from non-dippers in that they had significantly greater orthostatic heart rate increment (43 ± 16. bpm vs. 35 ± 10. bpm, P= 0.007) and significantly greater orthostatic plasma norepinephrine increase (293 ± 136.6. pg/ml vs. 209 ± 91.1. pg/ml, P= 0.028). Our data indicate that in patients with POTS, a non-dipping blood pressure profile is associated with a reduced orthostatic sympathetic reactivity not accounted for by autonomic neuropathy.
AB - Whether non-dipping - the loss of the physiologic nocturnal drop in blood pressure - among patients with postural tachycardia syndrome (POTS) is secondary to autonomic neuropathy, a hyperadrenergic state, or other factors remains to be determined. In 51 patients with POTS (44 females), we retrospectively analyzed 24-hour ambulatory blood pressure recordings, laboratory indices of autonomic function, orthostatic norepinephrine response, 24-hour natriuresis and peak exercise oxygen consumption. Non-dipping (<. 10% day-night drop in systolic blood pressure) was found in 55% (n= 28). Dippers and non-dippers did not differ in: 1) baseline characteristics including demographic and clinical profile, sleep duration, daytime blood pressure, 24-hour natriuresis, and peak exercise oxygen consumption; 2) severity of laboratory autonomic deficits (sudomotor, cardiovagal and adrenergic); 3) frequency of autonomic neuropathy (7/23 vs. 8/28, P= 0.885); 4) supine resting heart rate (75.3 ± 14.0. bpm vs. 74.0 ± 13.8. bpm, P= 0.532); or 5) supine plasma norepinephrine level (250.0 ± 94.9. pg/ml vs. 207.0 ± 86.8. pg/ml, P= 0.08). However, dippers differed significantly from non-dippers in that they had significantly greater orthostatic heart rate increment (43 ± 16. bpm vs. 35 ± 10. bpm, P= 0.007) and significantly greater orthostatic plasma norepinephrine increase (293 ± 136.6. pg/ml vs. 209 ± 91.1. pg/ml, P= 0.028). Our data indicate that in patients with POTS, a non-dipping blood pressure profile is associated with a reduced orthostatic sympathetic reactivity not accounted for by autonomic neuropathy.
KW - Ambulatory blood pressure
KW - Circadian blood pressure rhythm
KW - Dipping
KW - Orthostatic intolerance
KW - Postural tachycardia syndrome
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U2 - 10.1016/j.autneu.2014.06.003
DO - 10.1016/j.autneu.2014.06.003
M3 - Article
C2 - 25033770
AN - SCOPUS:84908068922
SN - 1566-0702
VL - 185
SP - 107
EP - 111
JO - Autonomic Neuroscience: Basic and Clinical
JF - Autonomic Neuroscience: Basic and Clinical
ER -