Skin Sympathetic Nerve Activity and Nocturnal Blood Pressure Nondipping in Patients with Postural Orthostatic Tachycardia Syndrome

Objective:Postural orthostatic tachycardia syndrome (POTS) is associated with abnormal blood pressure (BP) regulation and increased prevalence of nocturnal nondipping. We hypothesized that nocturnal nondipping of BP is associated with elevated skin sympathetic nerve activity (SKNA) in POTS.Method:We used an ambulatory monitor to record SKNA and electrocardiogram from 79 participants with POTS (36 & PLUSMN; 11 years, 72 women), including 67 with simultaneous 24-h ambulatory BP monitoring.Results:Nocturnal nondipping of BP was present in 19 of 67 (28%) participants. The nondipping group had a higher average SKNA (aSKNA) from midnight of day 1 to 0100 h on day 2 than the dipping group (P = 0.016, P = 0.030, respectively). The differences (& UDelta;) of aSKNA and mean BP between daytime and night-time were more significant in the dipping group compared with the nondipping group (& UDelta;aSKNA 0.160 & PLUSMN; 0.103 vs. 0.095 & PLUSMN; 0.099 & mu;V, P = 0.021, and & UDelta;mean BP 15.0 & PLUSMN; 5.2 vs. 4.9 & PLUSMN; 4.2 mmHg, P < 0.001, respectively). There were positive correlations between & UDelta;aSKNA and standing norepinephrine (NE) (r = 0.421, P = 0.013) and the differences between standing and supine NE levels (r = 0.411, P = 0.016). There were 53 (79%) patients with SBP less than 90 mmHg and 61 patients (91%) with DBP less than 60 mmHg. These hypotensive episodes were associated with aSKNA of 0.936 & PLUSMN; 0.081 and 0.936 & PLUSMN; 0.080 & mu;V, respectively, which were both significantly lower than the nonhypotensive aSKNA (1.034 & PLUSMN; 0.087 & mu;V, P < 0.001 for both) in the same patient.Conclusion:POTS patients with nocturnal nondipping have elevated nocturnal sympathetic tone and blunted reduction of SKNA between day and night. Hypotensive episodes were associated with reduced aSKNA.