Both ivabradine and propranolol reduced tachycardia and symptoms of postural orthostatic tachycardia syndrome (POTS), compared with placebo, based on findings from a randomized, double-blind crossover trial published in JACC and JACC: Advances.

Investigators Jaiden Uppal, BSc, Satish R. Raj, MD, FACC, et al., enrolled 28 female patients with POTS (mean age, 33 years) to three randomized four-week treatment phases of ivabradine 5 mg twice daily, propranolol 10 mg four times daily and placebo, with seven-day washout periods between each phase.

Results during 10-minute head-up tilt testing showed that both ivabradine (ΔHR_peak, 24 beats/min) and propranolol (ΔHR_peak, 25 beats/min) significantly reduced orthostatic tachycardia below the ΔHR ≥30 beats/min POTS diagnostic threshold vs. placebo (ΔHR_peak, 33 beats/min; p_drug<0.001).

There was no significant difference between ivabradine and propranolol (ΔHR_peak, 22 beats/min vs. 23 beats/min; p_drug=0.09). Ivabradine produced greater increase in systolic blood pressure vs. propranolol (4.9 mm Hg vs. 1.9 mm Hg; p_drug=0.001); propranolol improved psychomotor performance.

"Symptom and quality-of-life improvements were selective rather than uniform, and patient preferences were divided between active medications, highlighting interindividual variability in tolerability and perceived benefit," investigators also note. "Treatment selection should be individualized based on clinical phenotype and patient experience."

In another study focused on women, researchers found a 2.6-fold increase in testosterone prescriptions over the past decade. Using data from Epic Cosmos, an Epic electronic health record dataset on >300 million patients from nearly 45,000 hospitals and clinics, investigators Ido Avivi, MD, et al., analyzed testosterone prescribing records for women from 2016 to 2025.

Published in JACC: Advances, results showed that prescribing rates rose significantly from 50.0 to 130.8 per 100,000 among eligible women, with a marked acceleration after 2021 (32% annual increase from 2022 to 2025; incidence rate ratio, 1.32). By 2025, this corresponded to 90,482 prescriptions (59% increase from 2024), with the highest use among midlife women (45-64 years) accounting for 62% of prescriptions (274.5 per 100,000), a 79% increase from 2024. Investigators noted substantial racial disparities, with White women representing 80% of prescriptions (357 per 100,000).

Prescribing was most commonly associated with menopausal symptoms (35%), decreased libido (24%) and hormone replacement therapy (17%), while the only evidence-based indication – hypoactive sexual desire disorder – accounted for only 8% of cases. Notably, 51% of women had one or more cardiometabolic risk factors (hypertension, dyslipidemia or diabetes) and 44% had family history of heart disease, although baseline ischemic heart disease prevalence was slightly lower than in women who did not take testosterone (3.1% vs. 4.7%).

"Midlife is a critical period for atherosclerotic disease development in women, with the first myocardial infarction occurring on average [two] decades after menopause," write the study authors. "Given sex-specific differences in hormonal milieu, thrombotic susceptibility, treatment indications, and the routes and dosages used in clinical practice, the increasing prescription of testosterone in midlife women observed in this study warrants dedicated safety assessment."