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Auton. Res."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Muscle sympathetic nerve activity (MSNA) is valuable for managing postural tachycardia syndrome (POTS), but microneurography is clinically impractical. We investigated whether the Valsalva phase\u00a02 diastolic blood pressure rise (DBP\n                      <jats:sub>VM2l_rise<\/jats:sub>\n                      ) serves as a sympathetic marker and proposed enhanced neurovascular transduction as a pathophysiological mechanism in hyperadrenergic POTS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We included 21 POTS women and 22\u00a0healthy women to perform Valsalva and microneurography. MSNA spike rate was obtained using stationary wavelet transformation. The DBP\n                      <jats:sub>VM2l_rise<\/jats:sub>\n                      cut point for hyperadrenergic POTS was optimized by the golden section search with its correlation to phase\u00a02 MSNA spike rate as an objective function. We defined peripheral sympathetic neurovascular transduction (psNVT) as a ratio of DBP\n                      <jats:sub>VM2l_rise<\/jats:sub>\n                      to early phase\u00a02 MSNA increase. We compared Valsalva responses between the identified hyperadrenergic and non-hyperadrenergic POTS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The DBP\n                      <jats:sub>VM2l_rise<\/jats:sub>\n                      strongly correlated with the Valsalva phase\u00a02 MSNA spike rate percentage change from baseline in healthy (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.874,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The DBP\n                      <jats:sub>VM2l_rise<\/jats:sub>\n                      cutoff criterion of 15\u00a0mmHg optimally separated POTS into 7\u00a0hyperadrenergic (\u2265\u200915\u00a0mmHg,\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.902,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014) and 14 non-hyperadrenergic (&lt;\u200915\u00a0mmHg,\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.629,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021). Although similar MSNA spike rate, the hyperadrenergic group had higher baseline systolic blood pressure (118\u2009\u00b1\u200910 vs 105\u2009\u00b1\u200912\u00a0mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026), shorter pressure recovery time (1.15\u2009\u00b1\u20090.75 vs 2.59\u2009\u00b1\u20091.17\u00a0s,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048), and higher psNVT (2.60\u2009\u00b1\u20091.02 vs 0.58\u2009\u00b1\u20090.46\u00a0mmHg\/spike\u00b7s\n                      <jats:sup>\u22121<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) than the non-hyperadrenergic POTS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      DBP\n                      <jats:sub>VM2l_rise<\/jats:sub>\n                      \u2009\u2265\u200915\u00a0mmHg could be a sympathetic clinical marker and could identify hyperadrenergic POTS, characterized by enhanced neurovascular transduction despite comparable MSNA levels. This novel pathophysiological insight underscores the importance of sympathetic markers in POTS clinical management.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10286-025-01183-z","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:00:33Z","timestamp":1768395633000},"page":"271-283","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hyperadrenergic postural tachycardia syndrome associated with augmented neurovascular transduction"],"prefix":"10.1007","volume":"36","author":[{"given":"Surat","family":"Kulapatana","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis E.","family":"Okamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Rigo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasile","family":"Urechie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas W.","family":"Cayton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruijing E.","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giris","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William D.","family":"Dupont","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaello","family":"Furlan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Italo","family":"Biaggioni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5643-0294","authenticated-orcid":false,"given":"Andr\u00e9","family":"Diedrich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"1183_CR1","doi-asserted-by":"publisher","first-page":"102828","DOI":"10.1016\/j.autneu.2021.102828","volume":"235","author":"S Vernino","year":"2021","unstructured":"Vernino S, Bourne KM, Stiles LE, Grubb BP, Fedorowski A, Stewart JM, Arnold AC, Pace LA, Axelsson J, Boris JR, Moak JP, Goodman BP, Ch\u00e9mali KR, Chung TH, Goldstein DS, Diedrich A, Miglis MG, Cortez MM, Miller AJ, Freeman R, Biaggioni I, Rowe PC, Sheldon RS, Shibao CA, Systrom DM, Cook GA, Doherty TA, Abdallah HI, Darbari A, Raj SR (2021) Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1. 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