A 6-day high sodium diet (300 mEq/day) reduced upright heart rate and orthostatic tachycardia in POTS patients compared to a low sodium diet, and expanded plasma volume.
RCT (n=27)
Does a high sodium diet reduce orthostatic tachycardia and upright heart rate in patients with POTS?
A high sodium diet effectively reduces orthostatic tachycardia and standing norepinephrine while expanding plasma volume in patients with POTS, providing evidence to support current guideline recommendations.
Background: High sodium intake is recommended for the treatment of postural tachycardia syndrome (POTS) to counteract the hypovolemia and elevated plasma norepinephrine that contribute to excessive orthostatic tachycardia, but evidence of its efficacy is not available. Objectives: We tested whether a high sodium (HS) diet reduces orthostatic tachycardia (ΔHR) and upright heart rate (HR) compared with low sodium (LS) diet in POTS patients, and secondarily its effect on plasma volume (PV) and plasma norepinephrine. Methods: We enrolled 14 POTS patients and 13 healthy controls (HC), 23–49 years old, in a crossover study with six days of LS (10 mEq sodium/day) or HS (300 mEq sodium/day) diet. We measured supine and standing HR, blood pressure, serum aldosterone, plasma renin activity, blood volume, and plasma norepinephrine and epinephrine. Results: In POTS, HS diet reduced upright HR and ΔHR compared with LS diet. Total blood volume and PV increased, and standing norepinephrine decreased with HS compared with LS diet However, upright HR, ΔHR and upright norepinephrine remained higher in POTS than in HC on HS diet 117 (98–121) beats per minute (bpm), 46 (32–55) bpm, and 753 (498–919) pg/mL in POTS vs. 85 (77–95) bpm, 19 (11–32) bpm, and 387 (312–433) pg/mL in HC, despite no difference in the measured PV. Conclusions: In POTS patients, high dietary sodium intake compared with low dietary sodium intake increases plasma volume, lowers standing plasma norepinephrine, and decreases ΔHR. CONDENSED ABSTRACT Postural Tachycardia Syndrome (POTS) is a chronic form of orthostatic intolerance. Augmented oral sodium intake is a frequently prescribed treatment and recommended in professional society scientific statements on POTS, but evidence supporting the effectiveness was lacking. We evaluated one week of a very high sodium diet compared to a very low sodium diet in POTS patients. The high sodium diet expanded the plasma volume and total blood volume, reduced standing plasma norepinephrine levels (a marker of sympathetic nervous system tone), and reduced the orthostatic tachycardia. These data provide supporting evidence for the use of high sodium diets in POTS patients. ClinicalTrials.gov Identifier: NCT01547117
Garlandら（火曜日、）は、直立性頻脈症候群（POTS）でRCTを実施しました（n=27）。高ナトリウム食と低ナトリウム食（10 mEqナトリウム/日）を直立性頻脈（ΔHR）および直立心拍数（HR）に関して評価しました。6日間の高ナトリウム食（300 mEq/日）は、低ナトリウム食に比べてPOTS患者の直立心拍数および直立性頻脈を減少させ、血漿量を増加させました。
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