Blood pressure regulation in post-COVID POTS: beyond sinus tachycardia
File(s)
Author(s)
Type
Journal Article
Abstract
BACKGROUND:
Postural orthostatic tachycardia syndrome (POTS) is a frequently diagnosed cardiovascular disorder after COVID-19 infection. POTS is characterized by the presence of excessive sinus tachycardia on standing without a fall in blood pressure (BP). We investigated the BP profile using 24-hour ambulatory BP monitoring in patients with new-onset POTS after COVID-19 compared with prepandemic population-based controls.
METHODS:
We performed a case-control study in 100 patients (mean age, 40.0±12.9 years; 85% women) with verified post–COVID-19 new-onset POTS diagnosed by a positive head-up tilt testing versus 100 controls from a population-based cohort with a negative active standing test, no history of syncope, POTS, or endocrine disease (mean age, 42.3±14.0 years; 78% women). Twenty-four-hour BP profile was assessed for circadian BP variation including hypotensive systolic BP (SBP) episodes (<80, <90, and <100 mm Hg).
RESULTS:
Patients with post–COVID-19 POTS had significantly higher nighttime SBP, but not daytime SBP, and more daytime SBP hypotensive episodes compared with controls. Nondipping (34% versus 19%; P<0.001) and reverse dipping patterns (9% versus 0%; P<0.001) were more frequent in post–COVID-19 POTS. In the logistic regression, patients with post–COVID-19 POTS had significantly higher mean 24-hour SBP (odds ratio, 1.08 [95% CI, 1.04–1.11]; P<0.001) and nighttime SBP (odds ratio, 1.07 [95% CI, 1.04–1.10]; P<0.001), independent of age and sex.
CONCLUSIONS:
Patients with post–COVID-19 POTS demonstrate higher mean 24-hour and nighttime SBP and show disruptions of circadian BP rhythm regulation compared with population-based controls, as well as more daytime hypotensive episodes. Future studies are needed to test whether patients with post–COVID-19 POTS may benefit from tailored BP therapy.
Postural orthostatic tachycardia syndrome (POTS) is a frequently diagnosed cardiovascular disorder after COVID-19 infection. POTS is characterized by the presence of excessive sinus tachycardia on standing without a fall in blood pressure (BP). We investigated the BP profile using 24-hour ambulatory BP monitoring in patients with new-onset POTS after COVID-19 compared with prepandemic population-based controls.
METHODS:
We performed a case-control study in 100 patients (mean age, 40.0±12.9 years; 85% women) with verified post–COVID-19 new-onset POTS diagnosed by a positive head-up tilt testing versus 100 controls from a population-based cohort with a negative active standing test, no history of syncope, POTS, or endocrine disease (mean age, 42.3±14.0 years; 78% women). Twenty-four-hour BP profile was assessed for circadian BP variation including hypotensive systolic BP (SBP) episodes (<80, <90, and <100 mm Hg).
RESULTS:
Patients with post–COVID-19 POTS had significantly higher nighttime SBP, but not daytime SBP, and more daytime SBP hypotensive episodes compared with controls. Nondipping (34% versus 19%; P<0.001) and reverse dipping patterns (9% versus 0%; P<0.001) were more frequent in post–COVID-19 POTS. In the logistic regression, patients with post–COVID-19 POTS had significantly higher mean 24-hour SBP (odds ratio, 1.08 [95% CI, 1.04–1.11]; P<0.001) and nighttime SBP (odds ratio, 1.07 [95% CI, 1.04–1.10]; P<0.001), independent of age and sex.
CONCLUSIONS:
Patients with post–COVID-19 POTS demonstrate higher mean 24-hour and nighttime SBP and show disruptions of circadian BP rhythm regulation compared with population-based controls, as well as more daytime hypotensive episodes. Future studies are needed to test whether patients with post–COVID-19 POTS may benefit from tailored BP therapy.
Date Issued
2024-12-01
Date Acceptance
2024-10-04
Citation
Hypertension, 2024, 81 (12), pp.2540-2548
ISSN
0194-911X
Publisher
American Heart Association
Start Page
2540
End Page
2548
Journal / Book Title
Hypertension
Volume
81
Issue
12
Copyright Statement
© 2024 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39523946
Subjects
blood pressure
blood pressure monitoring, ambulatory
Cardiovascular System & Cardiology
COVID-19
Life Sciences & Biomedicine
ORTHOSTATIC INTOLERANCE
Peripheral Vascular Disease
post-acute COVID-19 syndrome
postural orthostatic tachycardia syndrome
Science & Technology
VALIDATION
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2024-11-11