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Circadian rhythms of blood pressure and rate pressure product in children with postural tachycardia syndrome

  • Hong Cai
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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  • Shuo Wang
    Affiliations
    Jishou University School of Medicine, Jishou, Hunan 416000, China
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  • Runmei Zou
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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  • Yuwen Wang
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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  • Cheng Wang
    Correspondence
    Corresponding author at: Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan 410011, China.
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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      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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      References

        • Atkinson G.
        • Leary A.C.
        • George K.P.
        • Murphy M.B.
        • Jones H.
        24-Hour variation in the reactivity of rate-pressure-product to everyday physical activity in patients attending a hypertension clinic.
        Chronobiol. Int. 2009; 26: 958-973https://doi.org/10.1080/07420520903044455
        • Birkenhäger A.M.
        • Van der Meiracker A.H.
        Causes and consequences of a non-dipping blood pressure profile.
        Neth. J. Med. 2007; 65: 127-131
        • Bowles N.P.
        • Thosar S.S.
        • Herzig M.X.
        • Shea S.A.
        Chronotherapy for hypertension.
        Curr. Hypertens. Rep. 2018; 20: 97https://doi.org/10.1007/s11906-018-0897-4
        • Brewster J.A.
        • Garland E.M.
        • Biaggioni I.
        • Black B.K.
        • Ling J.F.
        • Shibao C.A.
        • Robertson D.
        • Raj S.R.
        Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome.
        Clin. Sci. 2012; 122: 25-31https://doi.org/10.1042/CS20110077
        • Bryarly M.
        • Phillips L.T.
        • Fu Q.
        • Vernino S.
        • Levine B.D.
        Postural orthostatic tachycardia syndrome: JACC Focus Seminar.
        J. Am. Coll. Cardiol. 2019; 73: 1207-1228https://doi.org/10.1016/j.jacc.2018.11.059
        • Cao H.
        • Qin F.
        • Liu X.
        • Wang J.
        • Cao Y.
        • Tong J.
        • Zhao H.
        Circadian rhythmicity of antioxidant markers in rats exposed to 1.8 GHz radiofrequency fields.
        Int. J. Environ. Res. Public Health. 2015; 12: 2071-2087https://doi.org/10.3390/ijerph120202071
        • Cornelissen G.
        Cosinor-based rhythmometry.
        Theor. Biol. Med. Model. 2014; 11: 16https://doi.org/10.1186/1742-4682-11-16
        • Deedwania P.C.
        • Nelson J.R.
        Pathophysiology of silent myocardial ischemia during daily life: hemodynamic evaluation by simultaneous electrocardiographic and blood pressure monitoring.
        Circulation. 1990; 82: 1296-1304https://doi.org/10.1161/01.CIR.82.4.1296
        • Figueroa J.J.
        • Bott-Kitslaar D.M.
        • Mercado J.A.
        • Basford J.R.
        • Sandroni P.
        • Shen W.K.
        • Sletten D.M.
        • Gehrking T.L.
        • Gehrking J.A.
        • Low P.A.
        • Singer W.
        Decreased orthostatic adrenergic reactivity in non-dipping postural tachycardia syndrome.
        Auton. Neurosci. Basic Clin. 2014; 185: 107-111https://doi.org/10.1016/j.autneu.2014.06.003
        • Flynn J.T.
        • Daniels S.R.
        • Hayman L.L.
        • Maahs D.M.
        • McCrindle B.W.
        • Mitsnefes M.
        • Zachariah J.P.
        • Urbina E.M.
        Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association.
        Hypertension. 2014; 63: 1116-1135https://doi.org/10.1161/HYP.0000000000000007
        • Guo Y.F.
        • Stein P.K.
        Circadian rhythm in the cardiovascular system: chronocardiology.
        Am. Heart J. 2003; 145: 779-786https://doi.org/10.1016/S0002-8703(02)94797-6
        • Hermida R.C.
        • Fernández J.R.
        • Ayala D.E.
        • Mojón A.
        • Alonso I.
        • Smolensky M.
        Circadian rhythm of double (rate-pressure) product in healthy normotensive young subjects.
        Chronobiol. Int. 2001; 18: 475-489https://doi.org/10.1081/CBI-100103970
        • Huang Y.
        • Mai W.
        • Cai X.
        • Hu Y.
        • Song Y.
        • Qiu R.
        • Wu Y.
        • Kuang J.
        The effect of zolpidem on sleep quality, stress status, and nondipping hypertension.
        Sleep Med. 2012; 13: 263-268https://doi.org/10.1016/j.sleep.2011.07.016
        • JSC Joint Working Group
        Guidelines for the clinical use of 24 hour ambulatory blood pressure monitoring (ABPM) (JCS 2010)-digest version.
        Circ. J. 2012; 76: 508-519https://doi.org/10.1253/circj.CJ-88-0020
        • Lambert E.
        • Lambert G.
        Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome.
        Front. Physiol. 2014; 5: 280https://doi.org/10.3389/fphys.2014.00280
        • Li H.
        • Liao Y.
        • Wang Y.
        • Liu P.
        • Sun C.
        • Chen Y.
        • Tang C.
        • Jin H.
        • Du J.
        Baroreflex sensitivity predicts short-term outcome of postural tachycardia syndrome in children.
        PLoS One. 2016; 11e0167525https://doi.org/10.1371/journal.pone.0167525
        • Liao D.
        • Xu Y.
        • Zou R.
        • Wu L.
        • Luo X.
        • Li F.
        • Lin P.
        • Wang X.
        • Xie Z.
        • Wang C.
        The circadian rhythm of syncopal episodes in patients with neurally mediated syncope.
        Int. J. Cardiol. 2016; 215: 186-192https://doi.org/10.1016/j.ijcard.2016.04.086
        • Lin J.
        • Zhao H.
        • Shen J.
        • Jiao F.
        Salivary cortisol levels predict therapeutic response to a sleep-promoting method in children with postural tachycardia syndrome.
        J. Pediatr. 2017; 191: 91-95.e1https://doi.org/10.1016/j.jpeds.2017.08.039
        • Linsell C.R.
        • Lightman S.L.
        • Mullen P.E.
        • Brown M.J.
        • Causon R.C.
        Circadian rhythms of epinephrine and norepinephrine in man.
        J. Clin. Endocrinol. Metab. 1985; 60: 1210-1215https://doi.org/10.1210/jcem-60-6-1210
        • Macumber I.
        Ambulatory blood pressure monitoring in children and adolescents: a review of recent literature and new guidelines.
        Curr. Hypertens. Rep. 2017; 19: 96https://doi.org/10.1007/s11906-017-0791-5
        • Mar P.L.
        • Raj S.R.
        Postural orthostatic tachycardia syndrome: mechanisms and new therapies.
        Annu. Rev. Med. 2020; 71: 235-248https://doi.org/10.1146/annurev-med-041818-011630
        • Moon J.
        • Lee H.S.
        • Byun J.I.
        • Sunwoo J.S.
        • Shin J.W.
        • Lim J.A.
        • Kim T.J.
        • Shin Y.W.
        • Lee K.J.
        • Jeon D.
        • Jung K.H.
        • Lee S.T.
        • Jung K.Y.
        • Chu K.
        • Lee S.K.
        The complexity of diagnosing postural orthostatic tachycardia syndrome: influence of the diurnal variability.
        J. Am. Soc. Hypertens. 2016; 10: 263-270https://doi.org/10.1016/j.jash.2016.01.011
        • Mustafa H.I.
        • Garland E.M.
        • Biaggioni I.
        • Black B.K.
        • Dupont W.D.
        • Robertson D.
        • Raj S.R.
        Abnormalities of angiotensin regulation in postural tachycardia syndrome.
        Heart Rhythm. 2011; 8: 422-428https://doi.org/10.1016/j.hrthm.2010.11.009
        • Mustafa H.I.
        • Raj S.R.
        • Diedrich A.
        • Black B.K.
        • Paranjape S.Y.
        • Dupont W.D.
        • Williams G.H.
        • Biaggioni I.
        • Robertson D.
        Altered systemic hemodynamic and baroreflex response to angiotensin II in postural tachycardia syndrome.
        Circ. Arrhythm. Electrophysiol. 2012; 5: 173-180https://doi.org/10.1161/CIRCEP.111.965343
        • Okutucu S.
        • Karakulak U.N.
        • Kabakçi G.
        Circadian blood pressure pattern and cardiac autonomic functions: different aspects of same pathophysiology.
        Anadolu Kardiyol. Derg. 2011; 11: 168-173https://doi.org/10.5152/akd.2011.031
        • Raj S.R.
        • Biaggioni I.
        • Yamhure P.C.
        • Black B.K.
        • Paranjape S.Y.
        • Byrne D.W.
        • Robertson D.
        Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome.
        Circulation. 2005; 111: 1574-1582https://doi.org/10.1161/01.CIR.0000160356.97313.5D
        • Raj V.
        • Opie M.
        • Arnold A.C.
        Cognitive and psychological issues in postural tachycardia syndrome.
        Auton. Neurosci. Basic Clin. 2018; 215: 46-55https://doi.org/10.1016/j.autneu.2018.03.004
        • Robinson B.F.
        Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris.
        Circulation. 1967; 35: 1073-1083https://doi.org/10.1161/01.CIR.35.6.1073
        • Sheldon R.S.
        • Grubb B.P.
        • Olshansky B.
        • Shen W.K.
        • Calkins H.
        • Brignole M.
        • Raj S.R.
        • Krahn A.D.
        • Morillo C.A.
        • Stewart J.M.
        • Sutton R.
        • Sandroni P.
        • Friday K.J.
        • Hachul D.T.
        • Cohen M.I.
        • Lau D.H.
        • Mayuga K.A.
        • Moak J.P.
        • Sandhu R.K.
        • Kanjwal K.
        2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.
        Heart Rhythm. 2015; 12: e41-e63https://doi.org/10.1016/j.hrthm.2015.03.029
        • Silvani A.
        Sleep disorders, nocturnal blood pressure, and cardiovascular risk: a translational perspective.
        Auton. Neurosci. Basic Clin. 2019; 218: 31-42https://doi.org/10.1016/j.autneu.2019.02.006
        • Smolensky M.H.
        • Portaluppi F.
        • Manfredini R.
        • Hermida R.C.
        • Tiseo R.
        • Sackett-Lundeen L.L.
        • Haus E.L.
        Diurnal and twenty-four hour patterning of human diseases: cardiac, vascular, and respiratory diseases, conditions, and syndromes.
        Sleep Med. Rev. 2015; 21: 3-11https://doi.org/10.1016/j.smrv.2014.07.001
        • Stewart J.M.
        • Glover J.L.
        • Medow M.S.
        Increased plasma angiotensin II in postural tachycardia syndrome (POTS) is related to reduced blood flow and blood volume.
        Clin. Sci. 2006; 110: 255-263https://doi.org/10.1042/CS20050254
        • Stewart J.M.
        • Boris J.R.
        • Chelimsky G.
        • Fischer P.R.
        • Fortunato J.E.
        • Grubb B.P.
        • Heyer G.L.
        • Jarjour I.T.
        • Medow M.S.
        • Numan M.T.
        • Pianosi P.T.
        • Singer W.
        • Tarbell S.
        • Chelimsky T.C.
        Pediatric disorders of orthostatic intolerance.
        Pediatrics. 2018; 141https://doi.org/10.1542/peds.2017-1673
        • Uen S.
        • Baulmann J.
        • Düsing R.
        • Glänzer K.
        • Vetter H.
        • Mengden T.
        ST-segment depression in hypertensive patients is linked to elevations in blood pressure, pulse pressure and double product by 24-h Cardiotens monitoring.
        J. Hypertens. 2003; 21: 977-983https://doi.org/10.1097/00004872-200305000-00023
        • Wang C.
        • Li Y.
        • Liao Y.
        • Tian H.
        • Huang M.
        • Dong X.
        • Shi L.
        • Sun J.
        • Jin H.
        • Du J.
        2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents.
        Sci. Bull. 2018; 63: 1558-1564https://doi.org/10.1016/j.scib.2018.09.019
        • Zadourian A.
        • Doherty T.A.
        • Swiatkiewicz I.
        • Taub P.R.
        Postural orthostatic tachycardia syndrome: prevalence, pathophysiology, and management.
        Drugs. 2018; 78: 983-994https://doi.org/10.1007/s40265-018-0931-5