Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome

In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults reporting long COVID symptoms. Participants underwent a 3-min active stand (AS) with Finapres(®) NOVA, followed by a 10-min unmedicated 70° head-up tilt test. Eighty-five participants were included (mean age 46 years, range 25–78; 74% women), of which 56 (66%) reported OI during AS (OI(AS)). OI(AS) seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the first minute post-stand (mean HR(nadir): 88 vs. 75 bpm, P = 0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HR(nadir) was the only OI(AS) predictor (OR = 1.09, 95% CI: 1.01–1.18, P = 0.027). Twenty-two (26%) participants had initial (iOH) and 5 (6%) classical (cOH(AS)) orthostatic hypotension, but neither correlated with OI(AS). Seventy-one participants proceeded to tilt, of which 28 (39%) had OI during tilt (OI(tilt)). Of the 53 who had a 10-min tilt, 7 (13%) had an HR increase >30 bpm without cOH(tilt) (2 to HR > 120 bpm), but six did not report OI(tilt). In conclusion, OI(AS) was associated with a higher initial HR on AS, which after 1 min equalised with the non-OI(AS) group. Despite these initial orthostatic HR differences, POTS was infrequent (2%). ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).