Low-dose propranolol and exercise capacity in postural tachycardia syndrome a randomized study

Amy Arnold, Luis E. Okamoto, André Diedrich, Sachin Y. Paranjape, Satish R. Raj, Italo Biaggioni, Alfredo Gamboa

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective: To determine the effect of low-dose propranolol on maximal exercise capacity in patients with postural tachycardia syndrome (POTS). Methods: We compared the effect of placebo vs a single low dose of propranolol (20 mg) on peak oxygen consumption (VO2max), an established measure of exercise capacity, in 11 patients with POTS and 7 healthy subjects in a randomized, double-blind study. Subjects exercised on a semirecumbent bicycle, with increasing intervals of resistance to maximal effort. Results: Maximal exercise capacity was similar between groups following placebo. Low-dose propranolol improved VO2max in patients with POTS (24.5 ± 0.7 placebo vs 27.6 ± 1.0 mL/min/kg propranolol; p = 0.024), but not healthy subjects. The increase in VO2max in POTS was associated with attenuated peak heart rate responses (142 ± 8 propranolol vs 165 ± 4 bpm placebo; p = 0.005) and improved stroke volume (81 ± 4 propranolol vs 67 ± 3 mL placebo; p = 0.013). In a separate cohort of POTS patients, neither high-dose propranolol (80 mg) nor metoprolol (100 mg) improved VO2max, despite similar lowering of heart rate. Conclusions: These findings suggest that nonselective ß-blockade with propranolol, when used at the low doses frequently used for treatment of POTS, may provide a modest beneficial effect to improve heart rate control and exercise capacity. Classification of evidence: This study provides Class II evidence that a single low dose of propranolol (20 mg) as compared with placebo is useful in increasing maximum exercise capacity measured 1 hour after medication.

Original languageEnglish (US)
Pages (from-to)1927-1933
Number of pages7
JournalNeurology
Volume80
Issue number21
DOIs
StatePublished - May 21 2013

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Postural Orthostatic Tachycardia Syndrome
Propranolol
Exercise
Placebos
Heart Rate
Healthy Volunteers
Placebo Effect
Metoprolol
Double-Blind Method
Oxygen Consumption
Stroke Volume

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Arnold, A., Okamoto, L. E., Diedrich, A., Paranjape, S. Y., Raj, S. R., Biaggioni, I., & Gamboa, A. (2013). Low-dose propranolol and exercise capacity in postural tachycardia syndrome a randomized study. Neurology, 80(21), 1927-1933. https://doi.org/10.1212/WNL.0b013e318293e310
Arnold, Amy ; Okamoto, Luis E. ; Diedrich, André ; Paranjape, Sachin Y. ; Raj, Satish R. ; Biaggioni, Italo ; Gamboa, Alfredo. / Low-dose propranolol and exercise capacity in postural tachycardia syndrome a randomized study. In: Neurology. 2013 ; Vol. 80, No. 21. pp. 1927-1933.
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abstract = "Objective: To determine the effect of low-dose propranolol on maximal exercise capacity in patients with postural tachycardia syndrome (POTS). Methods: We compared the effect of placebo vs a single low dose of propranolol (20 mg) on peak oxygen consumption (VO2max), an established measure of exercise capacity, in 11 patients with POTS and 7 healthy subjects in a randomized, double-blind study. Subjects exercised on a semirecumbent bicycle, with increasing intervals of resistance to maximal effort. Results: Maximal exercise capacity was similar between groups following placebo. Low-dose propranolol improved VO2max in patients with POTS (24.5 ± 0.7 placebo vs 27.6 ± 1.0 mL/min/kg propranolol; p = 0.024), but not healthy subjects. The increase in VO2max in POTS was associated with attenuated peak heart rate responses (142 ± 8 propranolol vs 165 ± 4 bpm placebo; p = 0.005) and improved stroke volume (81 ± 4 propranolol vs 67 ± 3 mL placebo; p = 0.013). In a separate cohort of POTS patients, neither high-dose propranolol (80 mg) nor metoprolol (100 mg) improved VO2max, despite similar lowering of heart rate. Conclusions: These findings suggest that nonselective {\ss}-blockade with propranolol, when used at the low doses frequently used for treatment of POTS, may provide a modest beneficial effect to improve heart rate control and exercise capacity. Classification of evidence: This study provides Class II evidence that a single low dose of propranolol (20 mg) as compared with placebo is useful in increasing maximum exercise capacity measured 1 hour after medication.",
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Arnold, A, Okamoto, LE, Diedrich, A, Paranjape, SY, Raj, SR, Biaggioni, I & Gamboa, A 2013, 'Low-dose propranolol and exercise capacity in postural tachycardia syndrome a randomized study', Neurology, vol. 80, no. 21, pp. 1927-1933. https://doi.org/10.1212/WNL.0b013e318293e310

Low-dose propranolol and exercise capacity in postural tachycardia syndrome a randomized study. / Arnold, Amy; Okamoto, Luis E.; Diedrich, André; Paranjape, Sachin Y.; Raj, Satish R.; Biaggioni, Italo; Gamboa, Alfredo.

In: Neurology, Vol. 80, No. 21, 21.05.2013, p. 1927-1933.

Research output: Contribution to journalArticle

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T1 - Low-dose propranolol and exercise capacity in postural tachycardia syndrome a randomized study

AU - Arnold, Amy

AU - Okamoto, Luis E.

AU - Diedrich, André

AU - Paranjape, Sachin Y.

AU - Raj, Satish R.

AU - Biaggioni, Italo

AU - Gamboa, Alfredo

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N2 - Objective: To determine the effect of low-dose propranolol on maximal exercise capacity in patients with postural tachycardia syndrome (POTS). Methods: We compared the effect of placebo vs a single low dose of propranolol (20 mg) on peak oxygen consumption (VO2max), an established measure of exercise capacity, in 11 patients with POTS and 7 healthy subjects in a randomized, double-blind study. Subjects exercised on a semirecumbent bicycle, with increasing intervals of resistance to maximal effort. Results: Maximal exercise capacity was similar between groups following placebo. Low-dose propranolol improved VO2max in patients with POTS (24.5 ± 0.7 placebo vs 27.6 ± 1.0 mL/min/kg propranolol; p = 0.024), but not healthy subjects. The increase in VO2max in POTS was associated with attenuated peak heart rate responses (142 ± 8 propranolol vs 165 ± 4 bpm placebo; p = 0.005) and improved stroke volume (81 ± 4 propranolol vs 67 ± 3 mL placebo; p = 0.013). In a separate cohort of POTS patients, neither high-dose propranolol (80 mg) nor metoprolol (100 mg) improved VO2max, despite similar lowering of heart rate. Conclusions: These findings suggest that nonselective ß-blockade with propranolol, when used at the low doses frequently used for treatment of POTS, may provide a modest beneficial effect to improve heart rate control and exercise capacity. Classification of evidence: This study provides Class II evidence that a single low dose of propranolol (20 mg) as compared with placebo is useful in increasing maximum exercise capacity measured 1 hour after medication.

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