title: Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome.
abstract: We have found recently that exercise training is effective in the treatment of the postural orthostatic tachycardia syndrome (POTS). Whether this nondrug treatment is superior to "standard" drug therapies, such as β-blockade, is unknown. We tested the hypothesis that exercise training but not β-blockade treatment improves symptoms, hemodynamics, and renal-adrenal responses in POTS patients. Nineteen 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. Fifteen 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. We 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). These results suggest that, for patients with POTS, exercise training is superior to propranolol at restoring upright hemodynamics, normalizing renal-adrenal responsiveness, and improving quality of life.
authors.affiliation: Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave, Suite 435, Dallas, TX 75231, USA. QiFu@TexasHealth.org
authors.forename: Qi
authors.initials: Q
authors.lastname: Fu
authors.forename: Tiffany B
authors.initials: TB
authors.lastname: Vangundy
authors.forename: Shigeki
authors.initials: S
authors.lastname: Shibata
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Auchus
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Williams
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Levine
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D006306:Health Surveys; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D054972:Postural Orthostatic Tachycardia Syndrome / Q000503:physiopathology / Q000628:therapy*; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use*; D011788:Quality of Life; D012083:Renin / Q000097:blood; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000450:Aldosterone; D011433:Propranolol; D012083:Renin