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Evidence for Impaired Renin Activity in Postural Orthostatic Tachycardia Syndrome

Medic Spahic, Jasmina LU ; Yao Mattisson, Ingrid LU ; Hamrefors, Viktor LU orcid ; Johansson, Madeleine LU orcid ; Ricci, Fabrizio LU ; Nilsson, Jan LU ; Melander, Olle LU orcid ; Sutton, Richard and Fedorowski, Artur LU orcid (2023) In Journal of Clinical Medicine 12(14).
Abstract
Background: Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition predominantly affecting autonomic control of the cardiovascular system. Its extensive symptom diversity implies multi-organ involvement that interacts in ways still requiring full exploration. Current understanding of POTS pathophysiology suggests alterations in the renin–angiotensin–aldosterone system as a possible contributing factor. Therefore, we investigated the relationship between the activity of the renin–angiotensin–aldosterone system and hemodynamic parameters in a cohort of POTS patients and controls recruited at a tertiary referral center.

Methods: The case-control study included 46 patients with POTS (27 ± 9 years), and 48... (More)
Background: Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition predominantly affecting autonomic control of the cardiovascular system. Its extensive symptom diversity implies multi-organ involvement that interacts in ways still requiring full exploration. Current understanding of POTS pathophysiology suggests alterations in the renin–angiotensin–aldosterone system as a possible contributing factor. Therefore, we investigated the relationship between the activity of the renin–angiotensin–aldosterone system and hemodynamic parameters in a cohort of POTS patients and controls recruited at a tertiary referral center.

Methods: The case-control study included 46 patients with POTS (27 ± 9 years), and 48 healthy controls (30 ± 9 years) without orthostatic intolerance. Plasma renin activity, expressed as angiotensin I generation, and plasma aldosterone were measured by enzyme-linked immunosorbent assay and were correlated with hemodynamic parameters obtained during active standing tests.

Results: Renin activity was significantly downregulated in POTS patients compared to healthy individuals (median, 3406 ng/mL vs. 9949 ng/mL, p < 0.001), whereas aldosterone concentration did not differ between POTS and healthy controls (median, 218 pmol/L vs. 218 pmol/L, p = 0.26). A significant inverse correlation between renin activity and supine and orthostatic blood pressure levels was observed in healthy individuals (p < 0.05 for all), but not in POTS patients.

Conclusions: Renin activity, but not aldosterone concentration, is downregulated in patients with POTS. Moreover, renin activity in POTS is dissociated from supine and standing blood pressure levels in contrast to healthy individuals. These findings suggest impaired renin function in POTS, which may direct future therapeutic approaches. (Less)
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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
postural orthostatic tachycardia syndrome, renin, aldosterone, RAAS
in
Journal of Clinical Medicine
volume
12
issue
14
article number
4660
publisher
MDPI AG
external identifiers
  • pmid:37510775
  • scopus:85166299844
ISSN
2077-0383
DOI
10.3390/jcm12144660
language
English
LU publication?
yes
id
e13e601b-796f-4155-8532-6d1e111fa319
date added to LUP
2023-07-13 15:03:05
date last changed
2024-01-19 01:12:54
@article{e13e601b-796f-4155-8532-6d1e111fa319,
  abstract     = {{Background: Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition predominantly affecting autonomic control of the cardiovascular system. Its extensive symptom diversity implies multi-organ involvement that interacts in ways still requiring full exploration. Current understanding of POTS pathophysiology suggests alterations in the renin–angiotensin–aldosterone system as a possible contributing factor. Therefore, we investigated the relationship between the activity of the renin–angiotensin–aldosterone system and hemodynamic parameters in a cohort of POTS patients and controls recruited at a tertiary referral center. <br/><br/>Methods: The case-control study included 46 patients with POTS (27 ± 9 years), and 48 healthy controls (30 ± 9 years) without orthostatic intolerance. Plasma renin activity, expressed as angiotensin I generation, and plasma aldosterone were measured by enzyme-linked immunosorbent assay and were correlated with hemodynamic parameters obtained during active standing tests. <br/><br/>Results: Renin activity was significantly downregulated in POTS patients compared to healthy individuals (median, 3406 ng/mL vs. 9949 ng/mL, p &lt; 0.001), whereas aldosterone concentration did not differ between POTS and healthy controls (median, 218 pmol/L vs. 218 pmol/L, p = 0.26). A significant inverse correlation between renin activity and supine and orthostatic blood pressure levels was observed in healthy individuals (p &lt; 0.05 for all), but not in POTS patients. <br/><br/>Conclusions: Renin activity, but not aldosterone concentration, is downregulated in patients with POTS. Moreover, renin activity in POTS is dissociated from supine and standing blood pressure levels in contrast to healthy individuals. These findings suggest impaired renin function in POTS, which may direct future therapeutic approaches.}},
  author       = {{Medic Spahic, Jasmina and Yao Mattisson, Ingrid and Hamrefors, Viktor and Johansson, Madeleine and Ricci, Fabrizio and Nilsson, Jan and Melander, Olle and Sutton, Richard and Fedorowski, Artur}},
  issn         = {{2077-0383}},
  keywords     = {{postural orthostatic tachycardia syndrome; renin; aldosterone; RAAS}},
  language     = {{eng}},
  number       = {{14}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Clinical Medicine}},
  title        = {{Evidence for Impaired Renin Activity in Postural Orthostatic Tachycardia Syndrome}},
  url          = {{http://dx.doi.org/10.3390/jcm12144660}},
  doi          = {{10.3390/jcm12144660}},
  volume       = {{12}},
  year         = {{2023}},
}