Exercise Training Versus Propranolol in the Treatment of the Postural Orthostatic Tachycardia Syndrome
Exercise Training Versus Propranolol in the Treatment of the Postural Orthostatic Tachycardia Syndrome
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DOI：
10.1161/hypertensionaha.111.172262
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发表时间：
2011-08-01
期刊：
影响因子：
8.3
通讯作者：
Levine, Benjamin D.
中科院分区：
文献类型：
--
作者：
Fu, Qi;VanGundy, Tiffany B.;Levine, Benjamin D.
我们最近发现，运动训练是有效的治疗体位性直立性心动过速综合征（POTS）。这种非药物治疗是否上级“标准”药物治疗，如β-受体阻滞剂，尚不清楚。我们检验了运动训练而非β受体阻滞剂治疗改善POTS患者症状、血流动力学和肾-肾上腺反应的假设。19名患者（18名女性和1名男性）完成了为期4周的双盲药物试验（普萘洛尔或安慰剂），随后进行了3个月的运动训练。15名年龄匹配的健康个体（14名女性和1名男性）作为对照。在药物治疗和训练前后进行2小时站立试验。血流动力学，儿茶酚胺，血浆肾素活性，醛固酮测定仰卧和站立2小时。我们发现普萘洛尔和训练都能显著降低站立心率。普萘洛尔治疗后站立心输出量降低（P = 0.01），但训练后变化很小。醛固酮：在普萘洛尔治疗后，站立2小时期间的肾素比率保持不变（4.1 +/- 1.7 [SD]前vs 3.9 +/- 2.0; P = 0.46），但在训练后适度增加（5.2 +/- 2.9 vs 6.5 +/- 3.0; P = 0.05）。血浆儿茶酚胺不受普萘洛尔或训练。患者的生活质量，使用36项简式健康调查进行评估，在培训后得到改善（身体功能评分前33 +/- 10与后50 +/- 9;社会功能评分37 +/- 9与48 +/- 6;均P = 0.01），但在普萘洛尔治疗后未发生（34 +/- 10 vs 36 +/- 11，P = 0.63; 39 +/- 7 vs 39 +/- 5，P = 0.73）。这些结果表明，对于POTS患者，运动训练在恢复直立血流动力学、使肾-肾上腺反应性正常化和改善生活质量方面上级普萘洛尔。（高血压。2011;58：167-175）。在线补充资料
We have found recently that exercise training is effective in the treatment of the postural orthostatic tachycardia syndrome (POTS). Whether this nondrug treatment is superior to "standard" drug therapies, such as beta-blockade, is unknown. We tested the hypothesis that exercise training but not beta-blockade treatment improves symptoms, hemodynamics, and renal-adrenal responses in POTS patients. Nineteen patients (18 women and 1 man) completed a double-blind drug trial (propranolol or placebo) for 4 weeks, followed by 3 months of exercise training. Fifteen age-matched healthy individuals (14 women and 1 man) served as controls. A 2-hour standing test was performed before and after drug treatment and training. Hemodynamics, catecholamines, plasma renin activity, and aldosterone were measured supine and during 2-hour standing. We found that both propranolol and training significantly lowered standing heart rate. Standing cardiac output was lowered after propranolol treatment (P = 0.01) but was minimally changed after training. The aldosterone: renin ratio during 2-hour standing remained unchanged after propranolol treatment (4.1 +/- 1.7 [SD] before versus 3.9 +/- 2.0 after; P = 0.46) but modestly increased after training (5.2 +/- 2.9 versus 6.5 +/- 3.0; P = 0.05). Plasma catecholamines were not affected by propranolol or training. Patient quality of life, assessed using the 36-item Short-Form Health Survey, was improved after training (physical functioning score 33 +/- 10 before versus 50 +/- 9 after; social functioning score 37 +/- 9 versus 48 +/- 6; both P = 0.01) but not after propranolol treatment (34 +/- 10 versus 36 +/- 11, P = 0.63; 39 +/- 7 versus 39 +/- 5, P = 0.73). These results suggest that, for patients with POTS, exercise training is superior to propranolol at restoring upright hemodynamics, normalizing renal-adrenal responsiveness, and improving quality of life. (Hypertension. 2011;58:167-175.). Online Data Supplement