"There are no (U.S. Food and Drug Administration) approved drugs for patients with POTS and the current treatments that are available have numerous side effects including fatigue and lowering of blood pressure," said Dr. Pam R. Taub of the University of California, San Diego.
"We showed in our trial that ivabradine, which is a unique drug in that it lowers heart rate without impacting blood pressure, was well tolerated and beneficial in patients with POTS," she told Reuters Health by email.
The 22 patients in the trial, all but one of them women, were of the hyperadrenergic subtype, seen in up to 50% of POTS. This manifestation is characterized by abnormal sympathetic activation with the body being in a constant "flight or fight" mode.
Most patients had symptoms for up to three years before being diagnosed, Dr. Taub and her colleagues note in the Journal of the American College of Cardiology.
The participants were randomized to treatment with ivabradine or placebo for one month and then crossed over for a further month of treatment. The study was double-blinded, although "many patients noticed significant differences and suspected that they were on ivabradine."
Ivabradine reduced heart rate upon standing (77.9 vs. 94.2 beats per minute, P<0.001) and blunted the positional surge in heart rate from supine to standing (13.1 vs. 17.0, P<0.001).
Patients also reported significant improvements in quality of life and in social functioning with ivabradine.
"POTS often occurs after infections and we are seeing many cases of POTS after COVID-19 infection. This is a drug that can potentially be used in this population as well," Dr. Taub noted, adding that more research is needed.
Dr. Satish R. Raj of the University of Calgary, in Canada, co-author of an accompanying editorial, told Reuters Health by email that the study "provides high-quality data on how to help patients with postural orthostatic tachycardia syndrome."
"One challenge," he added, "is that many patients with POTS have had trouble affording medications like ivabradine, as many insurance companies have been hesitant to cover ivabradine for POTS. Hopefully, these high-quality data will help to make it easier for patients with postural orthostatic tachycardia syndrome to get the treatment that they need."
SOURCE: https://bit.ly/2Nlk2rE and https://bit.ly/3dzZxBW Journal of the American College of Cardiology, online January 15, 2021.
By David Douglas
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