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The Valsalva maneuver: screening for drug-induced baroreflex dysfunction

Clinical Autonomic Research volume 19, pages 32–38 (2009)Cite this article

Abstract

Objective

Many drugs can interfere with baroreflex mechanisms thereby impairing blood pressure control, but few have undergone sufficient testing. The state of affairs may be explained by the lack of simple and inexpensive screening tests.

Methods

In eleven healthy men, we tested the hypothesis that a simple Valsalva maneuver could detect drug-induced changes in baroreflex function that have previously been described using more elaborate and invasive methodologies. They performed Valsalva maneuvers after selective pharmacological inhibition of the norepinephrine transporter (NET) in a placebo-controlled, double-blind, randomized, crossover fashion. Patients with severe autonomic failure served as positive controls.

Results

NET inhibition profoundly augmented the blood pressure decrease during phase II and attenuated the blood pressure overshoot in phase IV compared with placebo. Furthermore, NET inhibition increased the heart rate response during the Valsalva maneuver.

Interpretation

The Valsalva maneuver recapitulated complex alterations in baroreflex regulation during NET inhibition. Thus, this simple and inexpensive test could be employed as a screening tool for drug-induced baroreflex dysfunction.

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Acknowledgments

We gratefully acknowledge the contributions of Prof. Christoph Hiemke and Sandra Heller of the Neuropsychiatric Laboratory of the University Mainz, Germany, who measured reboxetine plasma concentrations.

Sources of funding

The Deutsche Forschungsgemeinschaft (DFG) and the Bundesministerium für Bildung und Forschung (BMBF), Germany, supported the studies through grants awarded to J. Jordan.

Conflict of interest

None.

Author information

Affiliations

  1. Medical University Charité, Franz Volhard Clinical Research Center, Helios Klinikum Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany

    Christoph Schroeder & Friedrich C. Luft

  2. Institute of Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Karsten Heusser, Jens Tank & Jens Jordan MD

  3. Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN, USA

    André Diedrich

Authors
  1. Christoph Schroeder
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  2. Karsten Heusser
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  3. Jens Tank
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  4. André Diedrich
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  5. Friedrich C. Luft
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  6. Jens Jordan MD
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Corresponding author

Correspondence to Jens Jordan MD.

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Schroeder, C., Heusser, K., Tank, J. et al. The Valsalva maneuver: screening for drug-induced baroreflex dysfunction. Clin Auton Res 19, 32–38 (2009). https://doi.org/10.1007/s10286-008-0508-6

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  • DOI: https://doi.org/10.1007/s10286-008-0508-6

Keywords

  • clinical pharmacology
  • baroreflex
  • Valsalva maneuver
  • human
  • norepinephrine transporter