Menstrual cycle affects renal-adrenal and hemodynamic responses during prolonged standing in the postural orthostatic tachycardia syndrome

Qi Fu, Tiffany B. Vangundy, Shigeki Shibata, Richard J. Auchus, Gordon H. Williams, Benjamin D Levine

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Approximately 500 000 American premenopausal women have the postural orthostatic tachycardia syndrome (POTS). We tested the hypothesis that in POTS women during orthostasis, activation of the renin-angiotensin-aldosterone system is greater, leading to better compensated hemodynamics in the midluteal phase (MLP) than in the early follicular phase of the menstrual cycle. Ten POTS women and 11 healthy women (controls) consumed a constant diet 3 days before testing. Hemodynamics and renal-adrenal hormones were measured while supine and during 2-hour standing. We found that blood pressure was similar, heart rate and total peripheral resistance were greater, and cardiac output and stroke volume were lower in POTS subjects than in controls during 2-hour standing. In controls, hemodynamic parameters were indistinguishable between menstrual phases. In POTS subjects, cardiac output and stroke volume were lower and total peripheral resistance was greater in the early follicular phase than MLP after 30 minutes of standing; however, blood pressure and heart rate were similar between phases. Plasma renin activity (9±6 [SD] versus 13±9 ng/mL per hour; P=0.04) and aldosterone (43±22 versus 55±25 ng/dL; P=0.02) were lower in the early follicular phase than MLP in POTS subjects after 2 hours of standing. Catecholamine responses were similar between phases. The percentage rate of subjects having presyncope was greater in the early follicular phase than MLP for both groups (χ P<0.01). These results suggest that the menstrual cycle modulates the renin-angiotensin-aldosterone system and affects hemodynamics during orthostasis in POTS. The high estrogen and progesterone in the MLP are associated with greater increases in renal-adrenal hormones and presumably more volume retention, which improve late-standing tolerance in these patients.

Original languageEnglish (US)
Pages (from-to)82-90
Number of pages9
JournalHypertension
Volume56
Issue number1
DOIs
StatePublished - Jul 2010

Fingerprint

Postural Orthostatic Tachycardia Syndrome
Menstrual Cycle
Hemodynamics
Follicular Phase
Kidney
Cardiac Volume
Dizziness
Renin-Angiotensin System
Cardiac Output
Vascular Resistance
Stroke Volume
Heart Rate
Hormones
Blood Pressure
Syncope
Aldosterone
Renin
Catecholamines
Progesterone
Estrogens

Keywords

  • Hemodynamics
  • Orthostatic intolerance
  • Renin-angiotensin-aldosterone system
  • Sex hormones

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Menstrual cycle affects renal-adrenal and hemodynamic responses during prolonged standing in the postural orthostatic tachycardia syndrome. / Fu, Qi; Vangundy, Tiffany B.; Shibata, Shigeki; Auchus, Richard J.; Williams, Gordon H.; Levine, Benjamin D.

In: Hypertension, Vol. 56, No. 1, 07.2010, p. 82-90.

Research output: Contribution to journalArticle

Fu, Qi ; Vangundy, Tiffany B. ; Shibata, Shigeki ; Auchus, Richard J. ; Williams, Gordon H. ; Levine, Benjamin D. / Menstrual cycle affects renal-adrenal and hemodynamic responses during prolonged standing in the postural orthostatic tachycardia syndrome. In: Hypertension. 2010 ; Vol. 56, No. 1. pp. 82-90.
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