Use of Valsalva Maneuver to Detect Late-Onset Delayed Orthostatic Hypotension

Author:

Park Jin-Woo12ORCID,Okamoto Luis E.2ORCID,Kim Sung-Hwan1ORCID,Baek Seol-Hee1ORCID,Sung Joo Hye1,Jeon Namjoon1,Gamboa Alfredo2ORCID,Shibao Cyndya A.2ORCID,Diedrich André23,Kim Byung-Jo14ORCID,Biaggioni Italo2ORCID

Affiliation:

1. Department of Neurology, Korea University Medicine, Seoul (J.-W.P., S.-H.K., S.-H.B., J.H.S., N.J., B.-J.K.).

2. Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.-W.P., L.E.O., A.G., C.A.S., A.D., I.B.).

3. Department of Biomedical Engineering, Vanderbilt University, Nashville, TN (A.D.).

4. BK21 FOUR Program in Learning Health Systems, Korea University, Seoul (B.-J.K.).

Abstract

Background: Standard autonomic testing includes a 10-minute head-up tilt table test to detect orthostatic hypotension. Although this test can detect delayed orthostatic hypotension (dOH) between 3 and 10 minutes of standing, it cannot detect late-onset dOH after 10 minutes of standing. Methods: To determine whether Valsalva maneuver responses can identify patients who would require prolonged head-up tilt table test to diagnose late-onset dOH; patients with immediate orthostatic hypotension (onset <3 minutes; n=176), early-onset dOH (onset between 3 and 10 minutes; n=68), and late-onset dOH (onset >10 minutes; n=32) were retrospectively compared with controls (n=114) with normal head-up tilt table test and composite autonomic scoring scale score of 0. Results: Changes in baseline systolic blood pressure at late phase 2 (∆SBP VM2 ), heart rate difference between baseline and phase 3 (∆HR VM3 ), and Valsalva ratio were lower and pressure recovery time (PRT) at phase 4 was longer in late-onset dOH patients than in controls. Differences in PRT and ∆HR VM3 remained significant after correcting for age. A PRT ≥2.14 s and ∆HR VM3 ≤15 bpm distinguished late-onset dOH from age- and sex-matched controls. Patients with longer PRT (relative risk ratio, 2.189 [1.579–3.036]) and lower ∆HR VM3 (relative risk ratio, 0.897 [0.847–0.951]) were more likely to have late-onset dOH. Patients with longer PRT (relative risk ratio, 1.075 [1.012–1.133]) were more likely to have early-onset than late-onset dOH. Conclusions: Long PRT and short ∆HR VM3 can help to identify patients who require prolonged head-up tilt table test to diagnose late-onset dOH.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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