Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver


Measurement of beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver is the basis for a highly informative autonomic function test. Whereas in the past this measurement required intra-arterial cannulation, the development of finger cuff devices that acquire arterial pressure waveforms indistinguishable from those recorded intra-arterially has made it possible to obtain accurate measurements noninvasively. In a patient with orthostatic hypotension, the pattern of blood pressure responses during and after the release of the maneuver can identify a neurogenic basis: sympathetic neurocirculatory failure. The quantifiable change in cardiac interbeat interval per unit change in systolic pressure during the maneuver can identify baroreflex-cardiovagal failure.

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Autoimmune autonomic ganglionopathy


Autonomic nervous system


Chronic orthostatic intolerance




Multiple system atrophy


Orthostatic hypotension


Orthostatic intolerance


Pure autonomic failure


Parasympathetic nervous system


Postural tachycardia syndrome


Sympathetic adrenergic system


Sympathetic cholinergic system


Skin electrical conductance


Sympathetic noradrenergic system


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Correspondence to David S. Goldstein.

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The research reported here was supported by the Division of Intramural Research, NINDS, NIH (grant no. 1ZIANS003034).

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Goldstein, D.S., Cheshire, W.P. Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver. Clin Auton Res 27, 361–367 (2017).

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  • Autonomic
  • Sympathetic
  • Parasympathetic
  • Valsalva
  • Blood pressure