What the Latest JAMA Research Tells Us About POTS in 2026
Chung TH, Raj SR. Postural Orthostatic Tachycardia Syndrome (POTS): A Review. JAMA. 2026 Aug 24. doi: 10.1001/jama.2026.14809. Epub ahead of print. PMID: 42635998.
Published August 2026 | Research Spotlight
If you or someone you love is living with Postural Orthostatic Tachycardia Syndrome (POTS), you may sometimes wonder: is anyone actually researching this?
The answer, increasingly, is a resounding yes. In August 2026, one of the world's most prestigious medical journals, JAMA, published a comprehensive review of everything we currently know about POTS. Written by Dr Tae Hwan Chung and Dr Satish Raj (a leading figure in international POTS research), it draws on 103 studies and is a significant marker of how far the field has come.
POTS is More Common Than We Thought and More Recognised
For years, many people with POTS were told their symptoms were anxiety, deconditioning, or "all in their head." One reason for this? POTS didn't even have its own official diagnostic code until October 2022. That means doctors couldn't formally record a POTS diagnosis in medical systems before that date, making it nearly invisible in health data.
Now that better data is available, a 2025 study of 200 million US patients found the diagnostic prevalence of POTS at approximately 100 per 100,000 people and the authors note this is almost certainly an underestimate, because so many people remain undiagnosed. POTS predominantly affects females (around 90% of cases), with the highest incidence in the 13–29 year age group.
Median diagnostic delay remains 24 months from symptom onset. If that resonates with your story, you're far from alone.
POTS After COVID-19: What We Now Know
The review confirms what many in our community have experienced first-hand: COVID-19 has been a significant trigger for POTS. In 30–40% of cases, POTS symptoms begin within weeks of an infection including SARS-CoV-2, Epstein-Barr virus, and influenza.
The data on COVID-19 specifically is striking. People infected with SARS-CoV-2 have approximately a 2-fold higher relative risk of developing POTS, with pooled absolute rates of around 1% of infected individuals. One large study from Cedars-Sinai Medical Center found the risk of developing POTS was 5.3 times higher following SARS-CoV-2 infection compared to COVID-19 vaccination.
For those in our Long COVID community dealing with POTS: this paper explicitly names autonomic dysfunction including POTS as a recognised component of Long COVID, and notes it has been reported in 30–80% of patients with Long COVID in some studies. Your experience is real, it is documented, and research is actively being conducted.
New Research on Compression Garments: Good News for a Simple Intervention
One of the most exciting areas of new research involves something many of you may already be using: compression garments. The paper highlights two brand-new studies that give us much more confidence in recommending these as part of everyday management.
1. A community-based trial (2025) looked at commercially available high-waisted compression tights the kind you can buy off the shelf in 26 people with POTS at home, without medications. Wearing the tights reduced orthostatic tachycardia from a median of 44 beats per minute down to 24 beats per minute (p<0.001). When the tights were removed in the afternoon, heart rate increased again confirming that the garments were actively working throughout the day.
2. Abdominal-only compression (2026) a new study showed that compression focused only on the abdomen (rather than the full leg) also significantly reduced orthostatic tachycardia, from a median of 41 bpm to 27 bpm (p<0.001) in females with POTS. This is encouraging news for those who find full-leg compression uncomfortable or impractical, particularly in warmer climates like New Zealand summers.
The takeaway? Whether you use full high-waisted tights, abdominal binders, or cycling shorts, there is now strong real-world evidence that compression garments work and work meaningfully.
Exercise Therapy: A New Randomised Controlled Trial
Structured, supervised exercise remains the cornerstone of non-drug treatment for POTS, and this paper presents the first published randomised controlled trial on this topic in POTS. In the trial (49 participants), a 12-week semi-supervised exercise programme produced significant improvements compared to standard care:
· Peak oxygen uptake improved by 3.4 mL/kg/min (vs. a decline of 0.2 in the control group)
· Peak workload improved by 19 watts vs. 0 watts
· Orthostatic intolerance scores improved significantly
· Physical health-related quality of life scores improved significantly
Crucially, the programme began with recumbent (lying-down) exercise rowing machines, recumbent bikes, swimming with gradual progression to upright activity as tolerated. This is a key message: exercise in POTS must be tailored and graduated. Starting upright when you're symptomatic is not recommended and can make things worse. The authors specifically note that supervision by a physiotherapist or exercise physiologist is strongly recommended.
Medications: What's New?
The paper provides updated evidence on several medications used off-label for POTS. A few highlights:
Ivabradine vs Propranolol: head-to-head trial (2026): A brand-new randomised crossover trial directly compared ivabradine and propranolol against placebo. Both reduced heart rate more than placebo, and patients preferred both over placebo but there was no significant difference in patient preference between the two medications. This suggests both are reasonable options, and choice can be guided by individual tolerability and symptom profile.
Clonidine: A 2025 prospective observational study of 33 patients found that clonidine improved orthostatic blood flow and symptoms, with 80% of those who continued it for 6 months reporting fewer symptoms than at baseline. Useful particularly for people with prominent hyperadrenergic symptoms (surges of adrenaline, night sweats, racing heart at rest).
Desmopressin: A randomised crossover study of 30 patients showed that desmopressin significantly reduced standing heart rate and improved symptom scores compared to placebo offering a new blood-volume-expanding option, particularly for use on specific occasions or high-symptom days.
Importantly, the paper also highlights medications that can make POTS worse including spironolactone, some ADHD medications, some antidepressants (SNRIs), and certain blood pressure medications. If any of these are part of your medication list and your POTS symptoms are difficult to manage, it is worth discussing this with your doctor.
What Does the Future Look Like? Long-Term Outcomes
Perhaps one of the most significant new contributions is the first long-term outcomes data from a study with over 20 years of follow-up (Bourne et al., published online May 2026). In 44 adult patients followed for a median of 23 years after POTS symptom onset:
· Only 2% reported full resolution of symptoms
· 46% reported improvement over time
· 25% reported worsening
· 11% were unchanged; 16% had a variable course
This tells us that POTS is often a long-term condition requiring ongoing management but that for many people, things do improve. It also underscores the importance of pacing, active treatment, and long-term support which is exactly what organisations like Dysautonomia New Zealand are here to provide.
