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Cited by 58Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlCardiovascular Health and Disease Prevention

Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing

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Verheyden, Bart, Gisolf, Janneke, Beckers, Frank, Karemaker, John M., Wesseling, Karel H., Aubert, André E., Wieling, Wouter·2007·Clinical Science
DOI 10.1042/cs20070042
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Abstract

NTG (nitroglycerine) is used in routine tilt testing to elicit a vasovagal response. In the present study we hypothesized that with increasing age NTG triggers a more gradual BP (blood pressure) decline due to a diminished baroreflex-buffering capacity. The purpose of the present study was to examine the effect of NTG on baroreflex control of BP in patients with distinct age-related vasovagal collapse patterns. The study groups consisted of 29 patients (16–71 years old, 17 females) with clinically suspected VVS (vasovagal syncope) and a positive tilt test. Mean FAP (finger arterial pressure) was monitored continuously (Finapres). Left ventricular SV (stroke volume), CO (cardiac output) and SVR (systemic vascular resistance) were computed from the pressure pulsations (Modelflow). BRS (baroreflex sensitivity) was estimated in the time domain. In the first 3 min after NTG administration, BP was well-maintained in all patients. This implied an adequate arterial resistance response to compensate for steeper reductions in SV and CO with increasing age. HR (heart rate) increased and the BRS decreased after NTG administration. The rate of mean FAP fall leading to presyncope was inversely related to age (r=0.51, P=0.005). Accordingly, patients with a mean FAP fall >1.44 mmHg/s (median) were generally younger compared with patients with a slower mean FAP-fall (30±10 years compared with 51±17 years; P=0.001). The main determinant of the rate of BP fall on approach of presyncope was the rate of fall in HR (r=0.75, P<0.001). It was concluded that, in older patients, sublingual NTG provokes a more gradual BP decline compared with younger patients. This gradual decline cannot be ascribed to failure of the baroreflex-buffering capacity with increasing age. Age-related differences in the laboratory presentation of a vasovagal episode depend on the magnitude of the underlying bradycardic response.

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  • During orthostatic vasovagal syncope, the initial fall in blood pressure is driven by a roughly 50% decrease in cardiac output, and concurrent vasodilation occurs in only some patients.

    “The initial reduction in blood pressure during vasovagal syncope provoked by orthostatic stress is driven by a 50% decline in cardiac output, with coincident vasodilatation in only a subset of patients.78–80”

    From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [80]

    The Vasovagal episode section reports a marked fall in cardiac output in all patients before tilt-back, and The final vasovagal response section describes the nitroglycerine-triggered response as cardiac-output-mediated. Our copy does not quantify that fall as roughly 50% or report coincident vasodilation in a subset; it says systemic vascular resistance did not fall before the response. The findings also concern nitroglycerine-provoked tilt testing, rather than orthostatic vasovagal syncope generally (page numbers unavailable). (LLM, conf=0.88)

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Authors
Verheyden, B., Gisolf, J., Beckers, F., Karemaker, J. M., Wesseling, K. H., Aubert, A. E., & Wieling, W.
Affiliations
  • KU Leuven (BE)
  • Department of Physiology, Cardiovascular Research Institute, Academic Medical Centre, PO Box 22700, 1100 DD Amsterdam, The Netherlands
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Laboratory of Experimental Cardiology, University Hospital Gasthuisberg, K.U. Leuven, 3000 Leuven, Belgium
Corresponding author
  • Verheyden, Bart
  • Beckers, Frank
ORCID
Venue
Clinical Science
Publisher
Portland Press Ltd.
Published
2007-09-03
Volume
113
Issue
7
Pages
329-337
ISSN
  • 0143-5221 (ISSN-L)
  • 1470-8736
DOI
10.1042/cs20070042
OpenAlex
W2025265207
Semantic Scholar
ef6367a8c562584cd7ade9824544365535ab1bdd
Cited by
58
References
43
Citations by year
2026: 1 · 2025: 1 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 5 · 2016: 2 · 2015: 7 · 2014: 1 · 2013: 3 · 2012: 3
FWCI
7.99
Type
journal article
Language
en
Open access
Locations
  • Clinical Science (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • HAL (submittedVersion, other-oa)
  • Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion, other-oa)
Funders
  • European Space Agency
  • Belgian Federal Science Policy Office
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
vasovagal syncope, tilt table test, baroreflex sensitivity, age differences, blood pressure reduction, heart rate response, presyncope, stroke volume, cardiac output, systemic vascular resistance
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aging, Blood Pressure, Cardiac Output, Female, Nitroglycerin, Humans, Male, Middle Aged, Vascular Resistance, Vasodilation, Vasodilator Agents, Baroreflex, Head-Down Tilt, Tilt-Table Test, Syncope, Vasovagal

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