https://www.autonomicneuroscience.com/article/S1566-0702(18)30298-4/abstract
not open access
Short Communication - Autonomic Neuroscience
The autonomic reflex screen (ARS) has been established as an important clinical tool in the evaluation and diagnosis of autonomic disorders ( Low, 2003 ). Specifically, passive Head-up Tilt (HUT) to a minimum 60° angle from the horizontal provides an orthostatic challenge that is sensitive in diagnosing disorders of orthostatic intolerance, including but not limited to, neurogenic orthostatic hypotension, autonomic failure, postural orthostatic tachycardia syndrome, syncope, etc. ( Low and Benarroch, 2008 ).
While various pathologies can adversely affect normal autonomic functioning, age also plays a significant role in the responsiveness and integrity of the autonomic nervous system. Therefore, from a clinical perspective it is important to acquire and maintain normative data across various age groups to more clearly pars out the effects of normal aging versus a pathological state. For example, the current clinical definition of postural orthostatic tachycardia syndrome (POTS) is a heart rate (HR) increment ≥30 bpm on HUT or active standing and the absence of orthostatic hypotension (Low et al., 2008 ). However, in children and adolescents, previous reports demonstrate considerable overlap between patients and controls with 42% of the controls meeting or exceeding the HR criteria for POTS ( Singer et al., 2012 ). Moreover, in 2015 the Heart Rhythm Society released an expert consensus statement observing a HR increment ≥40 bpm should be considered in individuals aged 12–19 years ( Sheldon et al., 2015 ). However, a growing source of literature has begun to accumulate to suggest that these findings have expanded such that even young adults frequently manifest benign postural tachycardia at levels ≥30 bpm on HUT without any associated orthostatic symptoms ( Baker and Kimpinski, 2015 ).
To better understand ‘normal’ values, and to accurately assess the presence or absence of disease, clinicians require the most up-to-date and representative sample that can be acquired. As such, it is important for individual clinics to generate their own normative dataset to account for differences between different geographical regions, populations and laboratories ( Low and Benarroch, 2008 ). Therefore, the objective of the current report was to provide normative hemodynamic values with a specific focus on heart rate and blood pressure changes during Head-up Tilt that is representative of young, middle aged and older individuals from Ontario, Canada.
not open access
Short Communication - Autonomic Neuroscience
The autonomic reflex screen (ARS) has been established as an important clinical tool in the evaluation and diagnosis of autonomic disorders ( Low, 2003 ). Specifically, passive Head-up Tilt (HUT) to a minimum 60° angle from the horizontal provides an orthostatic challenge that is sensitive in diagnosing disorders of orthostatic intolerance, including but not limited to, neurogenic orthostatic hypotension, autonomic failure, postural orthostatic tachycardia syndrome, syncope, etc. ( Low and Benarroch, 2008 ).
While various pathologies can adversely affect normal autonomic functioning, age also plays a significant role in the responsiveness and integrity of the autonomic nervous system. Therefore, from a clinical perspective it is important to acquire and maintain normative data across various age groups to more clearly pars out the effects of normal aging versus a pathological state. For example, the current clinical definition of postural orthostatic tachycardia syndrome (POTS) is a heart rate (HR) increment ≥30 bpm on HUT or active standing and the absence of orthostatic hypotension (Low et al., 2008 ). However, in children and adolescents, previous reports demonstrate considerable overlap between patients and controls with 42% of the controls meeting or exceeding the HR criteria for POTS ( Singer et al., 2012 ). Moreover, in 2015 the Heart Rhythm Society released an expert consensus statement observing a HR increment ≥40 bpm should be considered in individuals aged 12–19 years ( Sheldon et al., 2015 ). However, a growing source of literature has begun to accumulate to suggest that these findings have expanded such that even young adults frequently manifest benign postural tachycardia at levels ≥30 bpm on HUT without any associated orthostatic symptoms ( Baker and Kimpinski, 2015 ).
To better understand ‘normal’ values, and to accurately assess the presence or absence of disease, clinicians require the most up-to-date and representative sample that can be acquired. As such, it is important for individual clinics to generate their own normative dataset to account for differences between different geographical regions, populations and laboratories ( Low and Benarroch, 2008 ). Therefore, the objective of the current report was to provide normative hemodynamic values with a specific focus on heart rate and blood pressure changes during Head-up Tilt that is representative of young, middle aged and older individuals from Ontario, Canada.
