What is the clinical evidence from this study?

Study design: RCT. Population: Postural Orthostatic Tachycardia Syndrome (POTS) (n=34). Intervention: Exercise training vs. Propranolol or placebo. Primary outcome: Patient quality of life (physical functioning score) (p=<0.01).

What question did this study set out to answer?

To determine whether exercise training is superior to standard beta-blocker therapy with propranolol in improving symptoms, hemodynamics, and renal-adrenal regulation in patients with postural orthostatic tachycardia syndrome.

June 21, 2011HypertensionOpen Access

Exercise Training Versus Propranolol in the Treatment of the Postural Orthostatic Tachycardia Syndrome

Q: What are the key findings of this study?

Exercise training was superior to propranolol in POTS patients, significantly improving physical functioning quality of life scores (50 vs 33 baseline; P<0.01) while propranolol did not (P=0.63).

Q: What question did this study set out to answer?

To determine whether exercise training is superior to standard beta-blocker therapy with propranolol in improving symptoms, hemodynamics, and renal-adrenal regulation in patients with postural orthostatic tachycardia syndrome.

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Key result

Exercise training was superior to propranolol in POTS patients, significantly improving physical functioning quality of life scores (50 vs 33 baseline; P<0.01) while propranolol did not (P=0.63).

Why the study?

Does exercise training improve symptoms, hemodynamics, and renal-adrenal responses compared to propranolol in patients with postural orthostatic tachycardia syndrome?

Key Points

To determine whether exercise training is superior to standard beta-blocker therapy with propranolol in improving symptoms, hemodynamics, and renal-adrenal regulation in patients with postural orthostatic tachycardia syndrome.
Nineteen patients with postural orthostatic tachycardia syndrome (18 women and 1 man) completed a double-blind drug trial comparing propranolol against placebo for 4 weeks, followed by 3 months of exercise training.
Fifteen age-matched healthy individuals (14 women and 1 man) served as controls, undergoing a 2-hour standing test before and after interventions to measure hemodynamics, catecholamines, plasma renin activity, and aldosterone.
Both propranolol and exercise training significantly lowered standing heart rate, but standing cardiac output declined only after propranolol (P=0.01) while remaining stable after training.
The standing aldosterone:renin ratio was unchanged by propranolol (4.1±1.7 before versus 3.9±2.0 after; P=0.46) but increased after training (5.2±2.9 versus 6.5±3.0; P=0.05).
Quality of life physical functioning scores significantly improved after exercise training (33±10 before versus 50±9 after; P<0.01) but not after propranolol (34±10 versus 36±11; P=0.63), with social functioning demonstrating a similar pattern (37±9 versus 48±6; P<0.01 versus 39±7 versus 39±5; P=0.73).

Study Design

Type

RCT (n=34)

Blinding

Double-blind

Structured PICO

Does exercise training improve symptoms, hemodynamics, and renal-adrenal responses compared to propranolol in patients with postural orthostatic tachycardia syndrome?

Population

19 patients with postural orthostatic tachycardia syndrome (POTS) (18 women, 1 man) and 15 age-matched healthy controls (14 women, 1 man).

Intervention

3 months of exercise training

Comparator

4 weeks of propranolol (administered during a preceding double-blind drug trial)

Outcome

Symptoms, hemodynamics, and renal-adrenal responses (including standing heart rate, cardiac output, aldosterone:renin ratio, plasma catecholamines, and quality of life)surrogate

Main Result

p-value: p=<0.01

Exercise training appears superior to propranolol for improving upright hemodynamics, normalizing renal-adrenal responsiveness, and enhancing quality of life in patients with POTS.

Authors

QFQi FuCross-Cutting Cardiology TVTiffany B. VanGundyTexas Health Dallas SSShigeki ShibataKyorin University

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports exercise training over propranolol as initial POTS therapy; extends RCT evidence for nonpharmacologic management.

Cite This Study

Fu et al. (2011) conducted an RCT in Postural Orthostatic Tachycardia Syndrome (POTS) (n=34). Exercise training vs. Propranolol or placebo was evaluated on Patient quality of life (physical functioning score) (p=<0.01). Exercise training was superior to propranolol in POTS patients, significantly improving physical functioning quality of life scores (50 vs 33 baseline; P<0.01) while propranolol did not (P=0.63).

synapsesocial.com/papers/6a0e4d87b60a7411ea891217 https://doi.org/10.1161/hypertensionaha.111.172262

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Exercise Training Versus Propranolol in the Treatment of the Postural Orthostatic Tachycardia Syndrome

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Exercise Training Versus Propranolol in the Treatment of the Postural Orthostatic Tachycardia Syndrome

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Also Consider