Key result
Adding splanchnic venous compression to propranolol yields a ~6-point reduction in POTS symptoms vs monotherapy.
Why the study?
Upright splanchnic venous pooling causes an exaggerated heart rate increase in postural tachycardia syndrome, prompting evaluation of whether abdominal compression reduces orthostatic tachycardia and symptoms.
Does abdominal compression, propranolol, or their combination improve heart rate, blood pressure, and symptoms in patients with postural tachycardia syndrome?
RCT (n=18)
Crossover
Does abdominal compression, propranolol, or their combination improve heart rate, blood pressure, and symptoms in patients with postural tachycardia syndrome?
Absolute Event Rate: -6% vs -1%
p-value: p=0.041
The combination of splanchnic venous compression and propranolol is more effective than either therapy alone in improving symptoms and maintaining standing blood pressure in patients with postural tachycardia syndrome.
Supports combined splanchnic compression plus propranolol for postural tachycardia syndrome symptoms; extends single-agent RCT evidence.
Background Splanchnic venous pooling induced by upright posture triggers a compensatory increase in heart rate ( HR ), a response that is exaggerated in patients with postural tachycardia syndrome. To assess whether abdominal compression attenuates orthostatic tachycardia and improves symptoms, 18 postural tachycardia syndrome patients (32±2 years) were randomized to receive either abdominal compression (40 mm Hg applied with an inflatable binder ≈2 minutes before standing) or propranolol (20 mg) in a placebo‐controlled, crossover study. Methods and Results Systolic blood pressure, HR , and symptoms were assessed while seated and standing, before and 2 hours postdrug. As expected, propranolol decreased standing HR compared with placebo (81±2 versus 98±4 beats per minute; P <0.001) and was associated with lower standing systolic blood pressure (93±2 versus 100±2 mm Hg for placebo; P =0.002). Compression had no effect on standing HR (96±4 beats per minute) but increased standing systolic blood pressure compared with placebo and propranolol (106±2 mm Hg; P <0.01). Neither propranolol nor compression improved symptoms compared with placebo. In 16 patients we compared the combination of abdominal compression and propranolol with propranolol alone. The combination had no additional effect on standing HR (81±2 beats per minute for both interventions) but prevented the decrease in standing systolic blood pressure produced by propranolol (98±2 versus 93±2 mm Hg for propranolol; P =0.029), and significantly improved total symptom burden (−6±2 versus −1±2 for propranolol; P =0.041). Conclusions Splanchnic venous compression alone did not improve HR or symptoms but prevented the blood pressure decrease produced by propranolol. The combination was more effective in improving symptoms than either alone. Splanchnic venous compression can be a useful adjuvant therapy to propranolol in postural tachycardia syndrome. Registration URL : https://www.clinicaltrials.gov ; Unique identifier: NCT 00262470.
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Smith et al. (2020) conducted an RCT in Postural tachycardia syndrome (n=18). Abdominal compression and propranolol vs. Propranolol alone was evaluated on Total symptom burden (p=0.041). The combination of splanchnic venous compression and propranolol significantly improved total symptom burden compared to propranolol alone (-6 vs -1; P=0.041) in postural tachycardia syndrome.
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