A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome: A Detailed Description
Authors' conclusion
Ivabradine and propranolol reduce orthostatic tachycardia vs placebo, lowering heart rate below POTS diagnostic criteria. Ivabradine elevates systolic blood pressuremore than propranolol, supporting personalized drug selection. Importantly, heart rate lowering was consistent whereas symptom and quality-of-life effects were more selective, supporting individualized treatment.
Study context
- Population
- Patients with postural orthostatic tachycardia syndrome (POTS)participants included in analyses (mean age 33 ± 9 years, 100% female)
- Participants
- 28 patients
- Comparison
- Ivabradine and propranolol vs placebo, and ivabradine vs propranolol, within participants
- Primary endpoint
- Delta heart rate during tilt (ΔHRPeak, standing - supine)
- Follow-up
- End of each 4-week phase, head-up tilt test
Methodological detailsthree 4-week treatment phases, 10-minute head-up tilt test with continuous beat-to-beat hemodynamic monitoring at the end of each phase, prespecified within-participant comparisons
- Three 4-week treatment phases
- 10-minute head-up tilt test with continuous beat-to-beat hemodynamic monitoring at the end of each phase
- Prespecified within-participant comparisons
Primary result
As reported in the abstract
Ivabradine
27
± 2 · beats/min
Propranolol
28
± 2 · beats/min
Placebo
36
± 2 · beats/min
Ivabradine vs placebo: P = 0.001 · propranolol vs placebo: P = 0.003
Further findings
HRPeak (peak heart rate in last 5 to 10 minutes of tilt) — ivabradine vs placebo · lower for ivabradine
P < 0.001
| Outcome | Ivabradine | Propranolol | Placebo | P value |
|---|---|---|---|---|
| HRPeak (peak heart rate in last 5 to 10 minutes of tilt)Propranolol vs placebo · lower for propranolol | P < 0.001 | |||
| Δ systolic blood pressureIvabradine vs propranolol · greater increase with ivabradine | 4.9 mm Hg | 1.9 mm Hg | — not stated in the abstract | P = 0.001 |
| Treatment preference · each phase endIvabradine vs placebo · all participants preferred ivabradine over placebo | 59% | 41% | — not stated in the abstract | P < 0.001 |
| Treatment preference · each phase endPropranolol vs placebo · all participants preferred propranolol over placebo | P < 0.001 | |||
| Treatment preference · each phase endIvabradine vs propranolol · no difference between active treatments | P = 0.52 |
— not stated in the abstract
- Treatment preference: Among 22 preferences
HRPeak (peak heart rate in last 5 to 10 minutes of tilt)
- No significant difference in HRPeak between ivabradine and propranolol
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →