Key result
Baseline heart rate variability is modestly associated with anxiety response to propranolol.
Why the study?
Heart rate variability may help identify autistic individuals most likely to benefit from propranolol for anxiety.
Does baseline resting HRV and other cardiac measures predict the response to propranolol for anxiety and core autism symptomology in autistic children and young adults?
Observational (n=62)
No
Does baseline resting HRV and other cardiac measures predict the response to propranolol for anxiety and core autism symptomology in autistic children and young adults?
Effect estimate: r = -0.19
p-value: p=0.046
Baseline resting heart rate variability and parasympathetic tone may serve as physiological biomarkers to identify autistic children and young adults most likely to experience anxiety and behavioral improvements from propranolol therapy.
Baseline HRV may identify propranolol responders in autistic youth; hypothesis-generating and requires prospective validation before clinical adoption.
Propranolol, a nonselective beta-adrenergic antagonist, has shown potential for improving anxiety in autistic individuals. Heart rate variability (HRV), a noninvasive cardiac marker of autonomic nervous system functioning, may help identify individuals most likely to benefit from propranolol. Objectives: Determine if baseline resting HRV and other cardiac measures predict the response to propranolol for anxiety and core autism symptomology in autistic children and young adults. Methods: Sixty-two autistic individuals (ages 7–24) participated in a two-phase (i.e., a 12-week randomized controlled trial and a 12-week open-label extension) trial of propranolol. Baseline (i.e., resting state, prior to treatment) HRV and other cardiac measures were obtained from an electrocardiogram. Clinical global impression for anxiety symptoms and overall behavioral treatment impact were assessed after the 12-week trial period. Group-level (i.e., all participants) and responder groups (i.e., strong, minimal, and non-responders to propranolol) were analyzed for treatment effects. Results: HRV variables predicted group-level anxiety response to propranolol, particularly for strong responders. Also, lower baseline values of parasympathetic HRV indices were significantly correlated with greater behavioral improvement after treatment with propranolol. Last, several baseline cardiac variables were associated with improvement in multiple behavioral domains after treatment with propranolol. Conclusions: HRV may be a potential biomarker for predicting reduced anxiety and behavioral symptoms in response to propranolol in autistic children and young adults. Identifying autonomic profiles associated with positive treatment outcomes could guide future personalized interventions in autism. The results presented herein should be regarded as preliminary until the findings are replicated in future clinical trials.
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Appling et al. (2025) conducted an observational in Autism spectrum disorder (ASD) (n=62). Baseline heart rate variability (HRV) was evaluated on Change in clinician-rated anxiety (CGI-I) (r = -0.19, p=0.046). Baseline heart rate variability variables significantly predicted anxiety response to 12 weeks of propranolol, with CGI-I Anxiety negatively correlated with pNN50 (r = -0.19) and positively correlated with STD HR (r = 0.25).
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