Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Am Coll Cardiol. 2021 May 4;77(17):2174-2184. doi: 10.1016/j.jacc.2021.03.005.
High sodium intake is recommended for the treatment of postural tachycardia syndrome (POTS) to counteract the hypovolemia and elevated plasma norepinephrine that contribute to excessive orthostatic tachycardia, but evidence of its efficacy is not available.
This study tested whether a high sodium (HS) diet reduces orthostatic tachycardia (Δ heart rate) and upright heart rate compared with a low sodium (LS) diet in POTS patients, and secondarily its effect on plasma volume (PV) and plasma norepinephrine.
A total of 14 POTS patients and 13 healthy control subjects (HC), age 23 to 49 years, were enrolled in a crossover study with 6 days of LS (10 mEq sodium/day) or HS (300 mEq sodium/day) diet. Supine and standing heart rate, blood pressure, serum aldosterone, plasma renin activity, blood volume, and plasma norepinephrine and epinephrine were measured.
In POTS, the HS diet reduced upright heart rate and Δ heart rate compared with the LS diet. Total blood volume and PV increased, and standing norepinephrine decreased with the HS compared with the LS diet. However, upright heart rate, Δ heart rate, and upright norepinephrine remained higher in POTS than in HC on the HS diet (median 117 beats/min [interquartile range: 98 to 121 beats/min], 46 beats/min [interquartile range: 32 to 55 beats/min], and 753 pg/ml [interquartile range: 498 to 919 pg/ml] in POTS vs. 85 beats/min [interquartile range: 77 to 95 beats/min], 19 beats/min [interquartile range: 11 to 32 beats/min], and 387 pg/ml [interquartile range: 312 to 433 pg/ml] in HC, respectively), despite no difference in the measured PV.
In POTS patients, high dietary sodium intake compared with low dietary sodium intake increases plasma volume, lowers standing plasma norepinephrine, and decreases Δ heart rate. (Dietary Salt in Postural Tachycardia Syndrome; NCT01547117).
高钠摄入被推荐用于治疗体位性心动过速综合征（POTS），以抵消导致过度直立性心动过速的低血容量和血浆去甲肾上腺素升高，但目前尚无其疗效的证据。
本研究旨在测试高钠（HS）饮食与低钠（LS）饮食相比，是否能降低 POTS 患者的直立性心动过速（Δ心率）和直立心率，并进一步观察其对血浆容量（PV）和血浆去甲肾上腺素的影响。
共纳入 14 名 POTS 患者和 13 名健康对照者（HC），年龄 23 至 49 岁，进行了一项交叉研究，共 6 天的 LS（10 mEq 钠/天）或 HS（300 mEq 钠/天）饮食。测量仰卧位和直立位心率、血压、血清醛固酮、血浆肾素活性、血容量以及血浆去甲肾上腺素和肾上腺素。
与 LS 饮食相比，HS 饮食降低了 POTS 患者的直立位心率和 Δ心率。与 LS 饮食相比，HS 饮食增加了总血容量和 PV，且站立时去甲肾上腺素降低。然而，与 LS 饮食相比，HS 饮食下 POTS 患者的直立位心率、Δ心率和直立位去甲肾上腺素仍高于 HC（中位数 117 次/分[四分位间距：98 至 121 次/分]、46 次/分[四分位间距：32 至 55 次/分]和 753 pg/ml[四分位间距：498 至 919 pg/ml]与 POTS 患者相比，85 次/分[四分位间距：77 至 95 次/分]、19 次/分[四分位间距：11 至 32 次/分]和 387 pg/ml[四分位间距：312 至 433 pg/ml]，尽管 PV 无差异）。
与低钠饮食相比，高钠饮食可增加 POTS 患者的血浆容量，降低站立时的血浆去甲肾上腺素水平，并降低 Δ心率。（体位性心动过速综合征中的饮食盐；NCT01547117）。
