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Head-up tilt table test: how far and how long?

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Abstract

There is great variation between laboratories in the angle and duration of tilt used in the head-up tilt table test. We compared the hemodynamic response to three sequential randomized 20-min tilts of 60°, 80° and 90° in 20 normal subjects. We studied 66 patients to determine the duration of tilt needed to document three types of orthostatic intolerance. Blood pressure and heart rate were monitored non-invasively. Thirty-nine patients with orthostatic hypotension of diverse causes and 17 patients with orthostatic tachycardia plus were tilted to 90° for 10 min. Ten patients with vasovagal syncope were tilted to 90° for 30 min. A multivariate analysis of variance performed to assess the hemodynamic responses to 60°, 80° and 90° tilts did not show a statistically significant difference (F=0.459). Logistic regression analyses revealed that the duration of tilt required to document orthostatic hypotension was 5 min (73% cases correctly identified), orthostatic tachycardia plus 10 min (86.5% cases correctly identified) and neurally mediated syncope 10 min (86.5% cases correctly identified). Tilt duration is a more important variable than tilt angle and the duration of the tilt should depend on the suspected cause of orthostatic intolerance.

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Authors and Affiliations

  1. Autonomic Reflex Laboratory, Union Memorial Hospital, 201 East University Parkway, 21218, Baltimore, Maryland

    R. K. Khurana MD

  2. University of Maryland School of Medicine, Baltimore, Maryland, USA

    E. M. Nicholas BA

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  1. R. K. Khurana MD
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  2. E. M. Nicholas BA
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Khurana, R.K., Nicholas, E.M. Head-up tilt table test: how far and how long?. Clinical Autonomic Research 6, 335–341 (1996). https://doi.org/10.1007/BF02556304

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