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Blood Pressure Regulation in Post–COVID POTS : Beyond Sinus Tachycardia

Johansson, Madeleine LU orcid ; Ståhlberg, Marcus ; Ricci, Fabrizio LU ; Lewinter, Christian ; Hamrefors, Viktor LU orcid ; Nilsson, Peter M. LU ; Sutton, Richard LU and Fedorowski, Artur LU orcid (2024) In Hypertension 81(12). p.2540-2548
Abstract
BACKGROUND:
Postural orthostatic tachycardia syndrome (POTS) is a frequently diagnosed cardiovascular disorder after COVID-19 infection. POTS is characterized by the presence of excessive sinus tachycardia on standing without a fall in blood pressure (BP). We investigated the BP profile using 24-hour ambulatory BP monitoring in patients with new-onset POTS after COVID-19 compared with prepandemic population-based controls.
METHODS:
We performed a case-control study in 100 patients (mean age, 40.0±12.9 years; 85% women) with verified post–COVID-19 new-onset POTS diagnosed by a positive head-up tilt testing versus 100 controls from a population-based cohort with a negative active standing test, no history of syncope, POTS, or... (More)
BACKGROUND:
Postural orthostatic tachycardia syndrome (POTS) is a frequently diagnosed cardiovascular disorder after COVID-19 infection. POTS is characterized by the presence of excessive sinus tachycardia on standing without a fall in blood pressure (BP). We investigated the BP profile using 24-hour ambulatory BP monitoring in patients with new-onset POTS after COVID-19 compared with prepandemic population-based controls.
METHODS:
We performed a case-control study in 100 patients (mean age, 40.0±12.9 years; 85% women) with verified post–COVID-19 new-onset POTS diagnosed by a positive head-up tilt testing versus 100 controls from a population-based cohort with a negative active standing test, no history of syncope, POTS, or endocrine disease (mean age, 42.3±14.0 years; 78% women). Twenty-four-hour BP profile was assessed for circadian BP variation including hypotensive systolic BP (SBP) episodes (<80, <90, and <100 mm Hg).
RESULTS:
Patients with post–COVID-19 POTS had significantly higher nighttime SBP, but not daytime SBP, and more daytime SBP hypotensive episodes compared with controls. Nondipping (34% versus 19%; P<0.001) and reverse dipping patterns (9% versus 0%; P<0.001) were more frequent in post–COVID-19 POTS. In the logistic regression, patients with post–COVID-19 POTS had significantly higher mean 24-hour SBP (odds ratio, 1.08 [95% CI, 1.04–1.11]; P<0.001) and nighttime SBP (odds ratio, 1.07 [95% CI, 1.04–1.10]; P<0.001), independent of age and sex.
CONCLUSIONS:
Patients with post–COVID-19 POTS demonstrate higher mean 24-hour and nighttime SBP and show disruptions of circadian BP rhythm regulation compared with population-based controls, as well as more daytime hypotensive episodes. Future studies are needed to test whether patients with post–COVID-19 POTS may benefit from tailored BP therapy. (Less)
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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood pressure, Covid-19, blood pressure monitoring, ambulatory, post-acute COVID-19 syndrome, postural orthostatic tachycardia syndrome
in
Hypertension
volume
81
issue
12
pages
9 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85209362792
  • pmid:39523946
ISSN
1524-4563
DOI
10.1161/HYPERTENSIONAHA.124.23670
project
Long-Haul Post-COVID-19 Symptoms Presenting as Postural Orthostatic Tachycardia Syndrome and Other Cardiovascular Dysautonomias
language
English
LU publication?
yes
id
f0dbae0e-5798-41eb-bd14-be6831210867
date added to LUP
2024-11-11 14:06:23
date last changed
2025-04-04 14:21:41
@article{f0dbae0e-5798-41eb-bd14-be6831210867,
  abstract     = {{BACKGROUND:<br/>Postural orthostatic tachycardia syndrome (POTS) is a frequently diagnosed cardiovascular disorder after COVID-19 infection. POTS is characterized by the presence of excessive sinus tachycardia on standing without a fall in blood pressure (BP). We investigated the BP profile using 24-hour ambulatory BP monitoring in patients with new-onset POTS after COVID-19 compared with prepandemic population-based controls.<br/>METHODS:<br/>We performed a case-control study in 100 patients (mean age, 40.0±12.9 years; 85% women) with verified post–COVID-19 new-onset POTS diagnosed by a positive head-up tilt testing versus 100 controls from a population-based cohort with a negative active standing test, no history of syncope, POTS, or endocrine disease (mean age, 42.3±14.0 years; 78% women). Twenty-four-hour BP profile was assessed for circadian BP variation including hypotensive systolic BP (SBP) episodes (&lt;80, &lt;90, and &lt;100 mm Hg).<br/>RESULTS:<br/>Patients with post–COVID-19 POTS had significantly higher nighttime SBP, but not daytime SBP, and more daytime SBP hypotensive episodes compared with controls. Nondipping (34% versus 19%; P&lt;0.001) and reverse dipping patterns (9% versus 0%; P&lt;0.001) were more frequent in post–COVID-19 POTS. In the logistic regression, patients with post–COVID-19 POTS had significantly higher mean 24-hour SBP (odds ratio, 1.08 [95% CI, 1.04–1.11]; P&lt;0.001) and nighttime SBP (odds ratio, 1.07 [95% CI, 1.04–1.10]; P&lt;0.001), independent of age and sex.<br/>CONCLUSIONS:<br/>Patients with post–COVID-19 POTS demonstrate higher mean 24-hour and nighttime SBP and show disruptions of circadian BP rhythm regulation compared with population-based controls, as well as more daytime hypotensive episodes. Future studies are needed to test whether patients with post–COVID-19 POTS may benefit from tailored BP therapy.}},
  author       = {{Johansson, Madeleine and Ståhlberg, Marcus and Ricci, Fabrizio and Lewinter, Christian and Hamrefors, Viktor and Nilsson, Peter M. and Sutton, Richard and Fedorowski, Artur}},
  issn         = {{1524-4563}},
  keywords     = {{Blood pressure; Covid-19; blood pressure monitoring, ambulatory; post-acute COVID-19 syndrome; postural orthostatic tachycardia syndrome}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{12}},
  pages        = {{2540--2548}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Hypertension}},
  title        = {{Blood Pressure Regulation in Post–COVID POTS : Beyond Sinus Tachycardia}},
  url          = {{http://dx.doi.org/10.1161/HYPERTENSIONAHA.124.23670}},
  doi          = {{10.1161/HYPERTENSIONAHA.124.23670}},
  volume       = {{81}},
  year         = {{2024}},
}