1Autonomic Dysfunction Center, Department of Medicine, Vanderbilt University, Nashville, USA.
J Psychopharmacol. 2014 Feb;28(2):155-61. doi: 10.1177/0269881113512911. Epub 2013 Nov 13.
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.
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.
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.
Sertraline had a modest pressor effect in POTS patients, but this did not translate into a reduced heart rate or improved symptoms.
选择性 5-羟色胺再摄取抑制剂（SSRIs）常用于治疗体位性心动过速综合征（POTS）患者，它们在突触末端发挥作用以增加单胺神经递质。我们假设它们通过增加血压和减轻反射性心动过速来改善症状。先前并未报道过 POTS 患者服用 SSRIs 后的急性血液动力学特征。
39 名 POTS 患者（F=37，39±9 岁）接受了一项舍曲林 50mg 和安慰剂的随机交叉试验。在药物或安慰剂给药前，患者先取坐位和立位各 10 分钟，然后每小时测量一次心率、收缩压、舒张压和平均血压，共 4 小时。主要终点为 4 小时时的站立心率。
4 小时时，舍曲林和安慰剂组的站立心率和收缩压无显著差异。与安慰剂相比，舍曲林后患者坐位的收缩压（106±12mmHg 比 101±8mmHg；p=0.041）、舒张压（72±8mmHg 比 69±8mmHg；p=0.022）和平均血压（86±9mmHg 比 81±9mmHg；p=0.007）均显著升高。4 小时时，舍曲林组的症状比安慰剂组更差。
舍曲林对 POTS 患者有适度的升压作用，但这并未转化为心率降低或症状改善。
