Cardio-oncology & otherRandomised controlled trial
A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome
- randomized, placebo-controlled, crossover trial
- 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
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 vs propranolol vs placebo
- Primary endpoint
- Delta heart rate during tilt (ΔHRPeak, standing - supine)
- Follow-up
- End of each 4-week phase, head-up tilt test
Primary result
As reported in the abstract
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 pressure · greater increase with ivabradine | 4.9 mm Hg | 1.9 mm Hg | Not reported in the abstract | P = 0.001 |
| Treatment preference · each phase end — ivabradine vs placebo · all participants preferred ivabradine over placebo | 59% | 41% | Not reported in the abstract | P < 0.001 |
| Treatment preference · each phase end — propranolol vs placebo · all participants preferred propranolol over placebo | P < 0.001 | |||
| Treatment preference · each phase end — ivabradine vs propranolol · no difference between active treatments | P = 0.52 |
- 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
Summarised from the published abstract; every number is checked against it