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Postural Orthostatic Tachycardia SyndromeNCT01563107

Dietary Sodium's Effect on Urinary Sodium and Dopamine Excretion in Patients With Postural Tachycardia Syndrome

A study testing Plasma Volume, Exercise Capacity Test - Bicycle and Posture Study in people with Postural Orthostatic Tachycardia Syndrome, run by Vanderbilt University Medical Center at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Patients with Postural Tachycardia Syndrome (POTS) may not adequately expand their plasma volume in response to a high sodium diet. Mechanisms involved in the regulation of plasma volume, such as the renin-angiotensin-aldosterone system and renal dopamine (DA), may be impaired in POTS and may respond inappropriately… Read more about this study

Who is it for?
Ages 18 to 50 years, women onlyHealthy volunteers can take part
What is being tested?
Plasma Volume, Exercise Capacity Test - Bicycle and Posture Study
Could I receive a placebo?
No, everyone receives an active treatment
How many people
38 participants
Where
1 siteUnited States
Study dates
Mar 2012to Dec 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 50 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Premenopausal patients with POTS and healthy volunteers, 18-50 years old, who are non-smokers and free of medications with the potential to influence blood pressure
  • Patients diagnosed with postural tachycardia syndrome by the Vanderbilt Autonomic Dysfunction Center
  • Patients who Increase heart rate ≥30 beats/min with position change from supine to standing (10 minutes)
  • For patients, chronic symptoms consistent with POTS that are worse when upright and get better with recumbence
  • Only female participants are eligible. Since 80-90% of POTS patients are female, and there can be differences in measures with the menstrual cycle, including a small number of males might introduce a significant amount of noise.
  • Able and willing to provide informed consent

Who cannot join

  • Smokers
  • Overt cause for postural tachycardia, i.e., acute dehydration
  • Significant cardiovascular, pulmonary, hepatic, or hematological disease by history or screening results
  • Positive pregnancy test or breastfeeding
  • Hypertension defined as BP>145/95 off medications when supine or needing antihypertensive medication
  • Other factors which in the investigator's opinion would prevent the participant from completing the protocol, including poor compliance during previous studies or an unpredictable schedule
  • Unable to give informed consent

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

Other trials in United States

About this study

Patients with Postural Tachycardia Syndrome (POTS) may not adequately expand their plasma volume in response to a high sodium diet. Mechanisms involved in the regulation of plasma volume, such as the renin-angiotensin-aldosterone system and renal dopamine (DA), may be impaired in POTS and may respond inappropriately to changes in dietary sodium. The investigators propose that the changes in urinary sodium and dopamine excretion caused by consuming low-sodium and high-sodium diets will be different between patients with POTS and healthy volunteers. The purpose of this study is to determine (1) whether changes in dietary sodium level appropriately influence sodium excretion in POTS; (2) whether changes in dietary sodium level appropriately influence DA excretion in POTS; (3) whether a high dietary sodium level appropriately expands plasma volume in POTS; and (4) whether patients with POTS have improvements in their orthostatic tachycardia and symptoms as a result of a high dietary sodium level.

Read the detailed description

Study Day 1

  • Start 150 mEq Na+/day diet (POTS patients as inpatients; healthy control subjects with Clinical Research Center(CRC)- provided outpatient diet); consume 1.5-2 liters of water per day
  • Start a 24hour (24hr) urine collection (for sodium (Na+), potassium (K+), creatinine (Cr), fractionated catecholamines)
  • Blood work

Study Days 2-5

  • Continue 24hr urine collection
  • Start STUDY DIET (10 mEq Na+/day or 300 mEq Na+/day in a random order) after 3 meals of 150 mEq Na+/day are complete; consume 1.5-2 liters of water per day
  • On Day 5, a 24 hr Holter combined ECG monitor and BP monitor will be placed on the subjects.

Study Day 6

  • Continue STUDY DIET; consume 1.5-2 liters of water per day
  • Remove 24hr Holter combined ECG monitor and BP monitor from subject
  • Continue 24hr urine collection (for Na+, K+, Cr, fractionated catecholamines)
  • Admit to CRC in afternoon (healthy control subjects only, as POTS patients will have already been admitted). Each subject will spend the night in the CRC and remain supine
  • Nothing by mouth (NPO) after midnight for study next day

Study Day 7

  • Awaken early (~6am) to void (still collecting 24hr urine)
  • Patient returns to bed, IV catheter inserted
  • Posture Study (in morning; between 7-8am ideally)
  • Blood pressure and heart rate will be measured while supine and then while standing for up to 30 minutes
  • We will draw blood in each body position to measure electrolytes and hormones that regulate blood pressure and blood volume
  • Subjects will rate symptoms during supine period and at end of stand using Vanderbilt Orthostatic Symptoms Score (VOSS)
  • Total Blood Volume (DAXOR)- using injection of iodinated I-131 tagged human serum albumin nominally 25 micro-Ci of radiation blood samples drawn through IV catheter before injection and for ~30 minutes post-injection (total - 25 ml)
  • This will be done after supine assessment, but before standing the subject up
  • Exercise Capacity Test (in the afternoon) Will estimate maximal oxygen consumption (VO2 max). This test will be conducted on a stationary bicycle. Effort will be gradually increased while expired air is measured during exhaustive physical work.

All procedures are repeated at least a month later with the 2nd level of dietary salt. (Randomized to high or low salt in the first phase, the second phase is the remaining level)

Being tested
Plasma Volume, Exercise Capacity Test - Bicycle, Posture Study
Keywords
Orthostatic Intolerance, Tachycardia, Orthostatic Hypotension, Sodium
Medical subject headings
Postural Orthostatic Tachycardia Syndrome, Orthostatic Intolerance, Tachycardia, Hypotension, Orthostatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Plasma VolumeRadiation

    Also called DAXOR

    Using injection of iodinated I-131 tagged human serum albumin nominally 25 micro-Ci of radiation, blood samples are drawn before and 30 minutes after injection.

  • Exercise Capacity Test - BicycleProcedure or surgery

    Also called VO2 Max (maximal oxygen consumption)

    subjects breathe room air through a mouthpiece and exhale the air into a tube that connects to a machine (metabolic cart) that analyzes carbon dioxide and oxygen content, which allows the investigator to calculate the amount of oxygen they are using under resting and exercise conditions.

  • Posture StudyProcedure or surgery

    Also called Standing Orthostatic Challenge

    Blood pressure and heart rate will be measured while supine and then while standing for up to 30 minutes. Blood will be drawn in each position to measure hormones that regulate blood pressure and blood volume.

Study groups in NCT01563107
Study groupRoleWhat they receive
High Salt DietExperimentalPOTS and healthy controls will be randomly assigned the order of dietary sodium levels. All procedures are performed at both levels. The high sodium diet will provide 300 milliequivalents (mEq) sodium/day.
Receives: Radiation: Plasma Volume; Procedure: Exercise Capacity Test - Bicycle; Procedure: Posture Study
Low Salt DietExperimentalPOTS and healthy controls will be randomly assigned the order of dietary sodium levels. All procedures are performed at both levels. The low sodium diet will provide 10 mEq sodium/day.
Receives: Radiation: Plasma Volume; Procedure: Exercise Capacity Test - Bicycle; Procedure: Posture Study

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 24hr Urinary Sodium

    Amount of sodium excreted in urine over 24hr ending on Day 7

    Measured: Day 6 am - Day 7 am for each dietary sodium level

  2. 24hr Urinary Dopamine

    Amount of dopamine excreted in urine over 24 hours ending on Day 7

    Measured: Between Day 6 am - Day 7 am of each dietary sodium level

Secondary outcomes (13)
  1. Plasma Volume

    Plasma volume (PV) was determined by the indicator tracer-dilution technique, using the DAXOR Blood Volume Analyzer (BVA)-100 system (DAXOR Corporation), on Day 7 of the low sodium and high sodium dietary interventions.

    Measured: after 7 days of each dietary sodium level

  2. Magnitude of Orthostatic Tachycardia

    Whether the magnitude of the heart rate increase that occurs in patients with POTS when moving from a supine to an upright position is attenuated by a High Sodium diet relative to a Low Sodium diet.

    Heart rate was assessed after overnight rest and fasting after midnight, following at least 60 minutes of lying quietly. Heart rate was then measured at intervals after subjects had been standing for up to 30 minutes (as tolerated). Differences between supine and standing values are presented for 5 minutes standing (or maximal stand if <5 minutes) since several patients were unable to stand for 10 minutes.

    Data in POTS patients were compared to that of Healthy Controls.

    Measured: Supine and upright heart rate were measured after 6 days of each dietary sodium level

  3. Upright Symptom Score

    Whether upright symptoms were improved in patients with POTS on a High Sodium diet relative to a Low Sodium diet.

    Patients were asked to report their standing symptom burden at the end of the Stand portion of the posture study, using the Vanderbilt Orthostatic Symptoms Scale (VOSS). They rated the severity of nine symptoms (palpitations, lightheadedness, mental confusion, blurred vision, shortness of breath, tremulousness, chest discomfort, headache, and nausea) on a scale ranging from a minimum of 0 (reflecting an absence of symptoms) to a maximum score of 10. The sum of the individual symptom scores was used to calculate orthostatic symptom burden for each participant. The lowest possible total score was 0, if a participant scored all 9 questions as 0, and the highest possible score was 90, if a participant scored all 9 questions as 10. Higher scores indicated worse symptoms.

    Measured: Upright symptoms were assessed on the 6th day of low or high sodium diet.

  4. Urinary Sodium Following Change in Dietary Sodium Days 1-2

    Urinary sodium excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 2 of each diet phase

  5. Urinary Dopamine Following Change in Dietary Sodium Days1-2

    Urinary dopamine excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 2 of each dietary sodium phase

  6. Urinary Sodium Following Change in Dietary Sodium Days 2-3

    Urinary sodium excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 3 of each diet phase

  7. Urinary Sodium Following Change in Dietary Sodium Days 3-4

    Urinary sodium excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 4 of each diet phase

  8. Urinary Sodium Following Change in Dietary Sodium Days 4-5

    Urinary sodium excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets

    Measured: 24 hour collections ending on Day 5 of each diet phase

  9. Urinary Sodium Following Change in Dietary Sodium Days 5-6

    Urinary sodium excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 6 of each diet phase

  10. Urinary Dopamine Following Change in Dietary Sodium Days 2-3

    Urinary dopamine excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 3 of each dietary sodium phase

  11. Urinary Dopamine Following Change in Dietary Sodium Days 3-4

    Urinary dopamine excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 4 of each dietary sodium phase

  12. Urinary Dopamine Following Change in Dietary Sodium Days 4-5

    Urinary dopamine excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 5 of each dietary sodium phase

  13. Urinary Dopamine Following Change in Dietary Sodium Days 5-6

    Urinary dopamine excretion will be measured every 24 hours as the participant adapts from the 150 mEq Na/day diet to the 10 and 300 mEq Na/day diets.

    Measured: 24 hour collections ending on Day 6 of each dietary sodium phase

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Mar 2012 (estimated)
  2. Study startMar 2012
  3. Primary completionDec 2020
  4. Study completionDec 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Randomised
Intervention model
Crossover
Model description
Randomization tables will be used to determine whether the 10 milliequivalents (mEq) sodium/day or 300 mEq sodium/day diet will be consumed first. Both diets will be completed on each subject (randomized crossover study), so all of the study procedures (after screening) will be repeated.
Masking
None (open label)
Enrolment
38 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01563107
Sponsor's protocol ID
VUMC 111633
Other IDs
R01HL071784
Status last verified
Dec 2021
First submitted
22 Mar 2012
Last updated
25 Jan 2022
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A study testing Plasma Volume, Exercise Capacity Test - Bicycle and Posture Study in people with Postural Orthostatic Tachycardia Syndrome, run by Vanderbilt University Medical Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Jan 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 25 Jan 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

24hr Urinary Sodium (time frame: Day 6 am - Day 7 am for each dietary sodium level). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jan 2022.

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