Postural Orthostatic Tachycardia Syndrome and Orthostatic Hypotension Following Hematopoietic Stem Cell Transplantation (JACC: CardioOncology State-of-the-Art Review June 2025)-Article: Postural Orthostatic Tachycardia Syndrome and Orthostatic Hypotension Following Hematopoietic Stem Cell Transplantation

Article: Postural Orthostatic Tachycardia Syndrome and Orthostatic Hypotension Following Hematopoietic Stem Cell Transplantation

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The study investigates the prevalence and occurrence of Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Hypotension (OH) in patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). Conducted at Virginia Commonwealth University Medical Center, it evaluates patients 30 days pre-transplant and again 30 and 100 days post-HSCT, measuring blood pressure, heart rate, and plasma norepinephrine changes to diagnose POTS and OH.<br /><br />Initially, 4.3% of the 46 patients had POTS or OH. At 30 days post-HSCT, 25.6% developed POTS and 15.4% OH, with 23.1% and 12.8% of these as new cases, respectively. By 100 days, the prevalence dropped to 14.3% for POTS and 5.7% for OH, with no new cases emerging, showing that some patients recovered over time.<br /><br />Patients with POTS showed exaggerated increases in norepinephrine levels and higher adrenergic receptor-modulating autoantibody activity upon standing, correlating with greater heart rate changes, indicating heightened sympathetic activation. The study underscores the commonality of POTS and OH following HSCT and highlights the importance of monitoring orthostatic vital signs and adrenergic activation markers for timely intervention.<br /><br />These findings suggest that treatments targeting sympathetic overactivity, such as beta-blockers or ivabradine, could be beneficial post-HSCT. While specific risk factors remain unidentified, ensuring routine assessments for symptoms of POTS and OH among HSCT recipients can aid in managing these conditions, thereby improving patient care and outcomes. The research highlights the need for further studies to explore preventative measures and optimal management for POTS and OH in cancer survivors.

Keywords

Postural Orthostatic Tachycardia Syndrome

Orthostatic Hypotension

Hematopoietic Stem Cell Transplantation

Virginia Commonwealth University Medical Center

blood pressure

heart rate

plasma norepinephrine

sympathetic activation

beta-blockers

adrenergic activation