From the Guidelines
Prolonged high salt intake in patients with Postural Orthostatic Tachycardia Syndrome (POTS) can lead to several long-term health concerns, including hypertension, cardiovascular disease, left ventricular hypertrophy, kidney damage, and fluid retention, and therefore, it is recommended to restrict total dietary sodium intake to approximately 2 g/day or less, as suggested by the most recent guidelines 1. The risk of these long-term health concerns varies based on individual salt sensitivity, kidney function, and genetic factors.
Key Considerations
- POTS patients should have regular blood pressure monitoring, kidney function tests, and cardiovascular assessments if maintaining high-salt diets long-term.
- A balanced approach might include using salt tablets (like Thermotabs, 1g sodium chloride per tablet, 2-3 times daily) rather than excessive dietary salt, combining salt with adequate hydration (2-3 liters daily), and exploring other POTS management strategies such as compression garments, exercise reconditioning, and medications like fludrocortisone or midodrine when appropriate.
- The physiological rationale for salt in POTS is that it increases plasma volume and cardiac output, helping counteract the blood pooling and autonomic dysfunction characteristic of the condition, but this benefit must be weighed against potential long-term cardiovascular risks, as highlighted in the 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults 2.
Management Strategies
- Restricting sodium intake to 2 g/day or less, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
- Combining salt with adequate hydration and exploring other POTS management strategies, such as compression garments, exercise reconditioning, and medications like fludrocortisone or midodrine when appropriate.
- Regular monitoring of blood pressure, kidney function, and cardiovascular health to minimize the risk of long-term health concerns associated with high salt intake. The 2013 ACCF/AHA guideline for the management of heart failure also suggests that sodium restriction is reasonable for patients with symptomatic heart failure to reduce congestive symptoms, but the evidence for this recommendation is modest 3. However, the most recent and highest quality study, the 2024 ESC guidelines, provides a more definitive recommendation for sodium restriction in patients with elevated blood pressure and hypertension 1.
From the Research
Long-term Effects of Excessive Sodium Intake in POTS Patients
- The long-term effects of excessive sodium intake in patients with Postural Orthostatic Tachycardia Syndrome (POTS) are not directly addressed in the provided studies, but some studies suggest that high sodium intake may be beneficial in the short-term for reducing orthostatic tachycardia and improving symptoms 4, 5.
- A study published in 2021 found that a high sodium diet increased plasma volume, lowered standing plasma norepinephrine, and decreased Δ heart rate in POTS patients compared to a low sodium diet 5.
- However, another study published in 2022 noted that while salt supplementation can improve symptoms and orthostatic responses in patients with POTS, its long-term effects on supine blood pressure and other cardiovascular outcomes are not well understood and should be routinely monitored 4.
- The potential long-term risks of excessive sodium intake in POTS patients, such as cardiovascular disease or other complications, are not explicitly discussed in the provided studies.
- A study published in 2012 reported on the long-term follow-up of POTS patients, but did not specifically address the effects of sodium intake 6.
- Overall, the available evidence suggests that high sodium intake may be beneficial for some POTS patients in the short-term, but the long-term effects of excessive sodium intake are not well understood and require further study 4, 5, 6.