Non-invasive measurement of adrenergic baroreflex during Valsalva maneuver reveals three distinct patterns in healthy subjects

Objective To investigate hemodynamic trans-phasic fluctuations in Valsalva maneuver (VM) and relate them to adrenergic baroreflex sensitivity (BRSa) indices. Methods In a healthy population ( n =107) with a young age predominance (32±15years) systolic blood pressure (SBP) and BRSa indices in VM were studied. Results Augmented and Suppressed Autonomic Responses (AAR, 28%; SAR, 15%, respectively), in addition to Balanced Autonomic Response (BAR, 40%), were found. There was a predominance for an unbalanced SBP response (67% in AAR, 69% in SAR, vs. 53% in BAR) in subjects ages 20–29. Compared to BAR and AAR, SAR had insignificant female predominance (51% and 47% vs. 75% respectively, p >0.05). AAR had the highest alternative BRSa (BRSa 1 ) compared to SAR and BAR (26.73±17.97mmHg/s vs. 8.64±5.33mmHg/s and 15.68±10.40mmHg/s respectively, p Conclusions Qualitative evaluation revealed three distinct patterns in response to VM. Late phase II was found to be a key factor in VM patterns and as such, argues to include late phase II parameters such as hemodynamic and time indices in BRSa evaluation. Significance These findings may be of use in future evaluations when identifying mild autonomic dysfunction and/or distinguishing typical and atypical SBP patterns in a healthy population.