Spahic Jasmina Medic, Mattisson Ingrid Yao, Hamrefors Viktor, Johansson Madeleine, Ricci Fabrizio, Nilsson Jan, Melander Olle, Sutton Richard, Fedorowski Artur
Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden.
Department of Internal Medicine, Skåne University Hospital, 214 28 Malmö, Sweden.
J Clin Med. 2023 Jul 13;12(14):4660. doi: 10.3390/jcm12144660.
Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition predominantly affecting autonomic control of the cardiovascular system. Its extensive symptom diversity implies multi-organ involvement that interacts in ways still requiring full exploration. Current understanding of POTS pathophysiology suggests alterations in the renin-angiotensin-aldosterone system as a possible contributing factor. Therefore, we investigated the relationship between the activity of the renin-angiotensin-aldosterone system and hemodynamic parameters in a cohort of POTS patients and controls recruited at a tertiary referral center.
The case-control study included 46 patients with POTS (27 ± 9 years), and 48 healthy controls (30 ± 9 years) without orthostatic intolerance. Plasma renin activity, expressed as angiotensin I generation, and plasma aldosterone were measured by enzyme-linked immunosorbent assay and were correlated with hemodynamic parameters obtained during active standing tests.
Renin activity was significantly downregulated in POTS patients compared to healthy individuals (median, 3406 ng/mL vs. 9949 ng/mL, < 0.001), whereas aldosterone concentration did not differ between POTS and healthy controls (median, 218 pmol/L vs. 218 pmol/L, = 0.26). A significant inverse correlation between renin activity and supine and orthostatic blood pressure levels was observed in healthy individuals ( < 0.05 for all), but not in POTS patients.
Renin activity, but not aldosterone concentration, is downregulated in patients with POTS. Moreover, renin activity in POTS is dissociated from supine and standing blood pressure levels in contrast to healthy individuals. These findings suggest impaired renin function in POTS, which may direct future therapeutic approaches.
体位性直立性心动过速综合征（POTS）是一种异质性疾病，主要影响心血管系统的自主控制。其广泛的症状多样性意味着多器官受累，其相互作用方式仍有待充分探索。目前对POTS病理生理学的理解表明，肾素-血管紧张素-醛固酮系统的改变可能是一个促成因素。因此，我们在一家三级转诊中心招募的一组POTS患者和对照组中，研究了肾素-血管紧张素-醛固酮系统的活性与血流动力学参数之间的关系。
这项病例对照研究纳入了46例POTS患者（27±9岁）和48例无直立不耐受的健康对照者（30±9岁）。通过酶联免疫吸附测定法测量以血管紧张素I生成表示的血浆肾素活性和血浆醛固酮，并将其与主动站立试验期间获得的血流动力学参数相关联。
与健康个体相比，POTS患者的肾素活性显著下调（中位数，3406 ng/mL对9949 ng/mL，<0.001），而POTS患者与健康对照者之间的醛固酮浓度没有差异（中位数，218 pmol/L对218 pmol/L，=0.26）。在健康个体中观察到肾素活性与仰卧位和直立位血压水平之间存在显著负相关（所有均<0.05），但在POTS患者中未观察到。
POTS患者的肾素活性下调，但醛固酮浓度未下调。此外，与健康个体相比，POTS患者的肾素活性与仰卧位和站立位血压水平无关。这些发现表明POTS患者的肾素功能受损，这可能指导未来的治疗方法。
