Highlights
- •Abnormal circadian blood pressure regulation (non-dipping blood pressure) is prevalent in POTS children
- •Sympathetic hyperactivity for POTS children mainly occurs during nocturnal sleep and within 3 h after waking
- •The excessive morning surge in RPP parallels with the morning surge of orthostatic HR increments
Abstract
Objective
To investigate circadian rhythms of blood pressure (BP) and rate pressure product
(RPP) in children with postural tachycardia syndrome (POTS) by performing 24-hour
ambulatory blood pressure monitoring (24-h ABPM).
Methods
103 POTS children and 84 age- and gender-matched healthy children were enrolled and
they got 24-h ABPM under usual routine of diurnal activity and nocturnal sleep.
Results
Although the mean awake systolic BP (SBP), 24-h diastolic BP (DBP), awake DBP, asleep
heart rate (HR) did not differ between two groups (P > 0.05), the mean 24-h and asleep SBP, asleep DBP, 24-h and awake HR, 24-h, awake
and asleep RPP were significantly higher in POTS children (P < 0.01). Non-dipping BP was more prevalent in POTS children (67.0% vs. 46%, P < 0.001). The RPP of POTS and control children showed 24-h circadian variations with
peak roughly occurring approximately 2 h after waking from nocturnal sleep. Compared
with controls, the RPP values of POTS children were significantly higher during 2 h
before and 3 h after waking (P < 0.05). For the RPP value of 1 h after waking, a cutoff value of 8995.6 bpm·mmHg
yielded a sensitivity of 75.8% and a specificity of 65.4% for predicting POTS.
Conclusions
Abnormal circadian BP regulation is prevalent in POTS children. POTS children present
with daily sympathetic hyperactivity, especially during nocturnal sleep and within
3 h after waking. And the excessive morning surge in RPP parallels with the morning
surge of orthostatic HR increments and OI symptoms.
Abbreviations:
24-h ABPM (24-hour ambulatory blood pressure monitoring), BP (blood pressure), DBP (diastolic blood pressure), ECG (electrocardiogram), HR (heart rate), HUTT (head-up tilt test), OI (orthostatic intolerance), POTS (postural tachycardia syndrome), RPP (rate-pressure product), SBP (systolic blood pressure.)Keywords
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Article info
Publication history
Published online: August 14, 2020
Accepted:
August 7,
2020
Received in revised form:
August 3,
2020
Received:
February 15,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
