Notice of Special Interest (NOSI): Stimulate Research on the Diagnosis, Treatment, and Mechanistic Understanding of Postural Orthostatic Tachycardia Syndrome (POTS)

Funding Agency:
National Institutes of Health

Individuals with Postural Orthostatic Tachycardia Syndrome (POTS) suffer from an excessive increase in heart rate (tachycardia) and other symptoms that worsen upon standing or sitting up, such as light-headedness, shortness of breath, chest pain, and palpitations. It is likely that POTS has multiple underlying mechanisms resulting in subtypes of POTS that need to be identified and characterized. There is evidence that POTS can arise from abnormalities in autonomic nervous system function, immune system function including autoimmunity, regulation of blood volume and blood flow, or a combination of these factors. Genetic factors probably also affect susceptibility to POTS. Many people with POTS report a preceding medical or life-changing event such as viral infection, concussion, surgery, pregnancy, or puberty. Due to the highly variable symptoms and signs of POTS across different people, it is likely that POTS is best defined as a syndrome with several subtypes that have distinct underlying causes.

There is no cure and no standardized therapy for POTS, and current treatment options focus on addressing symptoms rather than underlying disease processes. Many individuals with POTS benefit acutely from dietary salt and volume expansion, although there are no data on the long-term effects of such therapy. Drug therapies focused on increasing blood pressure, expanding blood volume, and lowering heart rate can also be helpful. Exercise training, with a primary focus on aerobic reconditioning, has also been shown to help. Non-cardiovascular symptoms may also benefit from treatment with non-pharmacological and pharmacological approaches.

POTS can be a debilitating condition that affects routine activities such as working or attending school. POTS primarily affects women of child-bearing age, with most studies reporting 80-90% female predominance. The peak incidence is at age 14 years, but half of all individuals with POTS develop it in adulthood. While there are no precise data on the prevalence of POTS, it is estimated to affect 0.2-1% of the U.S. population.

There is thus a compelling need to stimulate research to understand the causes of POTS in order to inform the development of treatments. Improving the diagnosis of POTS through the development of biomarkers or improved diagnostic tools represents another major need. Translational studies and mechanistic clinical trials to guide the development of better treatments are also important goals. This NOSI signals interest in this important area with the goal of stimulating research applications to address these critical needs.

This notice applies to due dates on or after June 5, 2021 and subsequent receipt dates through May 7, 2024.





Medical - Clinical Science
Medical - Translational

External Deadline

February 5, 2024