Efficacy of β-Blockers on Postural Tachycardia Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis

Abstract

Background: Postural tachycardia syndrome (POTS) is a severe health problem in children. Short-term β-blockers are recommended for pharmaceutical treatment. However, there have been contradictory data about its efficacy among pediatric patients.Methods and Results: Eight studies comparing β-blockers to conventional treatments for children with POTS were selected, where 497 cases of pediatric POTS were included. The efficacy of β-blockers was evaluated using the effective rate, the change of symptom score, the change of heart rate difference and adverse events. The results were stated as relative ratio (RR) and mean difference (MD) with a 95% confidence interval (95% CI). A random-effects meta-analysis for the effective rate indicated that β-blockers were more effective in treating pediatric POTS than controlled treatment (79.5 vs. 57.3%, RR = 1.50, 95%CI: 1.15–1.96, P < 0.05). A fixed-effects model analysis showed that β-blockers were more effective in lowering the symptom score and the heart rate increment during standing test than controlled treatment with a mean difference of 0.81 (95% CI: 0.44–1.18, P < 0.05) and 3.78 (95% CI: 2.10–5.46, P < 0.05), respectively. There were no reported severe adverse events in included studies.Conclusion: β-blockers are effective in treating POTS in children and adolescents, alleviating orthostatic intolerance, and improving hemodynamic abnormalities.

Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

“…Recently, intravenous metoprolol has been tested for use in the treatment of acute respiratory distress in acute COVID-19 and was found to improve oxygenation and reduce alveolar inflammation, shortening the duration of invasive mechanical ventilation overall [92]. Large-scale randomized evidence is eagerly awaited to confirm alleged pleiotropic anti-inflammatory effects of metoprolol [93] beyond its established safety, efficacy, and indications [94].…”

Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review

“…Two other systematic reviews of POTS treatment have been recently published. 35,36 One 36 was based on somewhat different inclusion criteria in that no comparison or control group was required; it also included studies of nonpharmacologic interventions. A total of 28 published studies was included, and interventions were, in general, associated with "improvement," even though the measures of improvement were incompletely validated symptom scores.…”

“…36 Similar to the current systematic review, the study by Wells and colleagues identified the paucity of relevant studies. The other 35 recent systematic review focused on beta blocker use and included several studies that were published in Chinese and, thus, not captured by the English language search strategy of the current study.…”

“…28 Separate from the current systematic review, Deng reviewed 8 studies from China (including 2 in this current systematic review 21,25 ) and found that when combining all 497 pediatric patients, beta blockers had a significantly favorable effect on orthostatic intolerance and hemodynamic function. 35…”

Baseline Corrected QT Interval Dispersion Is Useful to Predict Effectiveness of Metoprolol on Pediatric Postural Tachycardia Syndrome

“…Metoprolol exerts its therapeutic effect on POTS in children by inhibiting excessive sympathetic nerve function, decreasing HR, and the mechanical activation of ventricular wall baroreceptors, and inhibiting the effect of excessive plasm catecholamine content ( 7 – 10 ). However, the effective rate of metoprolol on POTS in children ranged from 57.1 to 57.89% ( 11 ). The main reason was that beta-adrenoceptor blockers could ameliorate the symptoms only for POTS children whose pathogenesis consisted of high catecholamine levels ( 11 ).…”