Acute hemodynamic effects of a selective serotonin reuptake inhibitor in postural tachycardia syndrome: a randomized, crossover trial

Abstract

Background: Selective serotonin reuptake inhibitors (SSRIs) are often prescribed in patients with postural tachycardia syndrome (POTS), and act at synaptic terminals to increase monoamine neurotransmitters. We hypothesized that they act to increase blood pressure and attenuate reflex tachycardia, thereby improving symptoms. Acute hemodynamic profiles after SSRI administration in POTS patients have not previously been reported.

Methods: Patients with POTS (n=39; F=37, 39 ±9 years) underwent a randomized crossover trial with sertraline 50mg and placebo. Heart rate, systolic, diastolic, and mean blood pressure were measured with the patient seated and standing for 10 min prior to drug or placebo administration, and then hourly for 4 h. The primary endpoint was standing heart rate at 4 h.

Results: At 4 h, standing heart rate and systolic blood pressure were not significantly different between sertraline and placebo. Seated systolic (106±12 mmHg vs. 101±8 mmHg; p=0.041), diastolic (72±8 mmHg vs. 69±8 mmHg; p=0.022), and mean blood pressure (86±9 mmHg vs. 81±9 mmHg; p=0.007) were significantly higher after sertraline administration than placebo. At 4 h, symptoms were worse with sertraline than placebo.

Conclusions: Sertraline had a modest pressor effect in POTS patients, but this did not translate into a reduced heart rate or improved symptoms.

Trial registration: ClinicalTrials.gov NCT00262470.

Keywords: SSRI; blood pressure; heart rate; postural tachycardia syndrome; sertraline.

Conflict of interest statement

Conflict of Interest Statement

The authors declare that there is no conflict of interest.

Figures

Figure 1. Heart rate and systolic blood pressure profiles of placebo and sertraline groups

(A) Seated, (B) standing, and (C) orthostatic ΔHR in profiles for placebo vs. sertraline are presented with HR measurements at baseline and at hour intervals for 4 hours after administration. Solid circles represent sertraline values while open boxes represent placebo values. (D) Seated, (E) standing, and (F) orthostatic changes in SBP profiles for placebo vs. sertraline are also presented with BP measurements at baseline and at hour intervals for 4 hours after administration. Repeated measures analysis of variance P values are also presented for the overall effect of the study drug over time (Pdrug). BPM: beats per minute; ΔHR changes in heart rate; SBP: systolic blood pressure; BP: blood pressure.

Figure 2. Mean arterial blood pressure and diastolic blood pressure profiles of placebo and sertraline groups

(A) Seated MAP, (B) standing MAP, (C) seated DBP, and (D) standing DBP profiles for placebo vs. sertraline 50mg are presented with BP measurements at baseline and at hour intervals for 4 hours after administration. Solid circles represent sertraline values while open boxes represent placebo values. P-value of paired samples t-test (2 tailed) for blood pressures at 4 hours between placebo and sertraline are shown. Repeated measures analysis of variance P values are also presented for the overall effect of the study drug over time (Pdrug). MAP: mean arterial pressure; DBP: diastolic blood pressure

Figure 3. Symptom profiles at baseline between placebo and sertraline groups

Panel (A) shows the symptom scores at baseline and then at 2 and 4 hours post administration of drug in the placebo and sertraline group. Panel (B) shows changes in symptom scores at 4 hours between placebo and sertraline. The P value was generated by using a paired t-test (2 tailed). Symptoms were recorded using the Vanderbilt Orthostatic Symptom Score (in arbitrary units). Lower scores correlate with lesser disease burden while higher scores correlate with greater disease burden. AU: arbitrary units