Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.
Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Auton Neurosci. 2022 Jan;237:102906. doi: 10.1016/j.autneu.2021.102906. Epub 2021 Nov 11.
Salt supplementation is a common non-pharmacological approach to the management of recurrent orthostatic syncope or presyncope, particularly for patients with vasovagal syncope (VVS) or postural orthostatic tachycardia syndrome (POTS), although there is limited consensus on the optimal dosage, formulation and duration of treatment. Accordingly, we reviewed the evidence for the use of salt supplementation to reduce susceptibility to syncope or presyncope in patients with VVS and POTS. We found that short-term (~3 months) salt supplementation improves susceptibility to VVS and associated symptoms, with little effect on supine blood pressure. In patients with VVS, salt supplementation is associated with increases in plasma volume, and an increase in the time taken to provoke a syncopal event during orthostatic tolerance testing, with smaller orthostatic heart rate increases, enhanced peripheral vascular responses to orthostatic stress, and improved cerebral autoregulation. Responses were most pronounced in those with a baseline sodium excretion <170 mmol/day. Salt supplementation also improved symptoms, plasma volume, and orthostatic responses in patients with POTS. Salt supplementation should be considered for individuals with recurrent and troublesome episodes of VVS or POTS without cardiovascular comorbidities, particularly if their typical urinary sodium excretion is low, and their supine blood pressure is not elevated. The efficacy of the response, in terms of the improvement in subjective and objective markers of orthostatic intolerance, and any potential deleterious effect on supine blood pressure, should be routinely monitored in individuals on high salt regimes.
盐补充是管理复发性体位性晕厥或先兆晕厥的常见非药物方法，特别是对于血管迷走性晕厥（VVS）或姿势性心动过速综合征（POTS）患者，尽管对于治疗的最佳剂量、配方和持续时间存在有限的共识。因此，我们回顾了盐补充剂用于降低 VVS 和 POTS 患者晕厥或先兆晕厥易感性的证据。我们发现，短期（约 3 个月）盐补充剂可改善 VVS 及相关症状的易感性，对仰卧位血压影响较小。在 VVS 患者中，盐补充剂与血浆体积增加有关，并在直立耐量试验中诱发晕厥事件的时间延长，直立心率增加较小，对外周血管对直立应激的反应增强，以及脑自动调节改善。在基线钠排泄量<170mmol/天的患者中，反应最为明显。盐补充剂也改善了 POTS 患者的症状、血浆体积和直立反应。对于没有心血管合并症的复发性和麻烦的 VVS 或 POTS 患者，应考虑盐补充剂，特别是如果他们的典型尿钠排泄量低，仰卧位血压不升高。应定期监测高盐方案个体的反应效果，即直立不耐受的主观和客观标志物的改善，以及对仰卧位血压的任何潜在有害影响。
