{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:22:21Z","timestamp":1790421741447,"version":"4.1.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2017,7,18]],"date-time":"2017-07-18T00:00:00Z","timestamp":1500336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2017,7,18]],"date-time":"2017-07-18T00:00:00Z","timestamp":1500336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.<\/jats:p>","DOI":"10.1038\/s41598-017-05668-4","type":"journal-article","created":{"date-parts":[[2017,7,12]],"date-time":"2017-07-12T13:20:29Z","timestamp":1499865629000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt"],"prefix":"10.1038","volume":"7","author":[{"given":"Hyung","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip A.","family":"Low","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Ah","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2017,7,18]]},"reference":[{"key":"5668_CR1","unstructured":"Low P. A. & Benarroch E. E. Clinical autonomic disorders (Lippincott Williams & Wilkins, 2008)."},{"key":"5668_CR2","doi-asserted-by":"publisher","first-page":"617","DOI":"10.4065\/70.7.617","volume":"70","author":"PA Low","year":"1995","unstructured":"Low, P. A. et al. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin. Proc. \n                           70, 617\u2013622 (1995).","journal-title":"Mayo Clin. Proc."},{"key":"5668_CR3","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/S0002-9343(97)89517-4","volume":"100","author":"C Ward","year":"1996","unstructured":"Ward, C. & Kenny, R. A. Reproducibility of orthostatic hypotension in symptomatic elderly. Am. J. Med. \n                           100, 418\u2013422 (1996).","journal-title":"Am. J. Med."},{"key":"5668_CR4","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1016\/j.amjmed.2008.10.040","volume":"122","author":"SD Arbogast","year":"2009","unstructured":"Arbogast, S. D., Alshekhlee, A., Hussain, Z., McNeeley, K. & Chelimsky, T. C. Hypotension unawareness in profound orthostatic hypotension. Am. J. Med. \n                           122, 574\u2013580 (2009).","journal-title":"Am. J. Med."},{"key":"5668_CR5","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.jns.2012.11.019","volume":"325","author":"HA Kim","year":"2013","unstructured":"Kim, H. A., Lee, H., Park, K. J. & Lim, J. G. Autonomic dysfunction in patients with orthostatic dizziness: validation of orthostatic grading scale and comparison of Valsalva maneuver and head-up tilt testing results. J. Neurol. Sci. \n                           325, 61\u201366 (2013).","journal-title":"J. Neurol. Sci."},{"key":"5668_CR6","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.autneu.2011.02.004","volume":"161","author":"R Freeman","year":"2011","unstructured":"Freeman, R. et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Auton. Neurosci. \n                           161, 46\u201348 (2011).","journal-title":"Auton. Neurosci."},{"key":"5668_CR7","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/S0025-6196(12)60631-4","volume":"68","author":"PA Low","year":"1993","unstructured":"Low, P. A. Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin. Proc. \n                           68, 748\u2013752 (1993).","journal-title":"Mayo Clin. Proc."},{"key":"5668_CR8","first-page":"2502","volume":"53","author":"P Novak","year":"2011","unstructured":"Novak, P. Quantitative autonomic testing. J. Vis. Exp. \n                           53, 2502 (2011).","journal-title":"J. Vis. Exp."},{"key":"5668_CR9","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1097\/00004691-199811000-00013","volume":"15","author":"JC Denq","year":"1998","unstructured":"Denq, J. C., O\u2019Brien, P. C. & Low, P. A. Normative data on phases of the Valsalva maneuver. J. Clin. Neurophysiol. \n                           15, 535\u2013540 (1998).","journal-title":"J. Clin. Neurophysiol."},{"key":"5668_CR10","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1212\/WNL.0b013e31821e5563","volume":"76","author":"P Novak","year":"2011","unstructured":"Novak, P. Assessment of sympathetic index from the Valsalva maneuver. Neurology. \n                           76, 2010\u20132016 (2011).","journal-title":"Neurology."},{"key":"5668_CR11","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1002\/mus.20853","volume":"36","author":"CC Huang","year":"2007","unstructured":"Huang, C. C., Sandroni, P., Sletten, D., Weigand, S. & Low, P. A. Effect of age on adrenergic and vagal baroreflex sensitivity in normal subjects. Muscle Nerve. \n                           36, 637\u2013642 (2007).","journal-title":"Muscle Nerve."},{"key":"5668_CR12","first-page":"39","volume":"28","author":"M Kirbis","year":"2013","unstructured":"Kirbis, M., Meglic, B. & Bajrovic, F. F. Comparison of active standing test, head-up tilt test and 24-h ambulatory heart rate and blood pressure monitoring in diagnosing postural tachycardia. Funct Neurol. \n                           28, 39 (2013).","journal-title":"Funct Neurol."},{"key":"5668_CR13","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1161\/01.STR.29.1.104","volume":"29","author":"V Novak","year":"1998","unstructured":"Novak, V., Novak, P., Spies, J. M. & Low, P. A. Autoregulation of cerebral blood flow in orthostatic hypotension. Stroke. \n                           29, 104\u2013111 (1998).","journal-title":"Stroke."},{"key":"5668_CR14","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1016\/j.mayocp.2012.08.013","volume":"87","author":"EE Benarroch","year":"2012","unstructured":"Benarroch, E. E. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin. Proc. \n                           87, 1214\u20131225 (2012).","journal-title":"Mayo Clin. Proc."},{"key":"5668_CR15","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1037\/0278-6133.22.6.643","volume":"22","author":"LM Benrud-Larson","year":"2003","unstructured":"Benrud-Larson, L. M., Sandroni, P., Haythornthwaite, J. A., Rummans, T. A. & Low, P. A. Correlates of functional disability in patients with postural tachycardia syndrome: Preliminary cross-sectional findings. Health Psychol. \n                           22, 643\u2013648 (2003).","journal-title":"Health Psychol."},{"key":"5668_CR16","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1111\/j.1540-8167.2008.01407.x","volume":"20","author":"PA Low","year":"2009","unstructured":"Low, P. A., Sandroni, P., Joyner, M. & Shen, W. K. Postural tachycardia syndrome (POTS). J. cardiovasc. electr \n                           20, 352\u2013358 (2009).","journal-title":"J. cardiovasc. electr"},{"key":"5668_CR17","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1152\/japplphysiol.00292.2013","volume":"115","author":"CT Ives","year":"2013","unstructured":"Ives, C. T. & Kimpinski, K. Higher postural heart rate increments on head-up tilt correlate with younger age but not orthostatic symptoms. J. Appl. Physiol. \n                           115, 525\u2013528 (2013).","journal-title":"J. Appl. Physiol."},{"key":"5668_CR18","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1016\/j.mayocp.2012.02.020","volume":"87","author":"K Kimpinski","year":"2012","unstructured":"Kimpinski, K. et al. A prospective, 1-year follow-up study of postural tachycardia syndrome. Mayo Clin. Proc. \n                           87, 746\u2013752 (2012).","journal-title":"Mayo Clin. Proc."},{"key":"5668_CR19","doi-asserted-by":"publisher","first-page":"2102","DOI":"10.1016\/j.clinph.2015.12.017","volume":"127","author":"H Lee","year":"2016","unstructured":"Lee, H. & Kim, H. A. Orthostatic hypertension: an underestimated cause of orthostatic intolerance. Clin Neurophysiol. \n                           127, 2102\u20132107 (2016).","journal-title":"Clin Neurophysiol."},{"key":"5668_CR20","doi-asserted-by":"publisher","first-page":"298","DOI":"10.3949\/ccjm.77a.09118","volume":"77","author":"JJ Figueroa","year":"2010","unstructured":"Figueroa, J. J., Basford, J. R. & Low, P. A. Preventing and treating orthostatic hypotension: as easy as A, B, C. Clev Clin J Med. \n                           77, 298 (2010).","journal-title":"Clev Clin J Med."},{"key":"5668_CR21","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1203\/00006450-200008000-00016","volume":"48","author":"JM Stewart","year":"2000","unstructured":"Stewart, J. M. Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion. Pediatr Res. \n                           48, 218\u2013226 (2000).","journal-title":"Pediatr Res."},{"key":"5668_CR22","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/BF02556304","volume":"6","author":"R Khurana","year":"1996","unstructured":"Khurana, R. & Nicholas, E. Head-up tilt table test: how far and how long? Clin Auton Res \n                           6, 335\u2013341 (1996).","journal-title":"Clin Auton Res"},{"key":"5668_CR23","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1016\/j.jash.2015.02.006","volume":"9","author":"B McJunkin","year":"2015","unstructured":"McJunkin, B. et al. Detecting initial orthostatic hypotension: a novel approach. J Am Soc Hypertens. \n                           9, 365\u2013369 (2015).","journal-title":"J Am Soc Hypertens."},{"key":"5668_CR24","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1159\/000368699","volume":"43","author":"T Gurevich","year":"2014","unstructured":"Gurevich, T. et al. Head-up tilt testing for detecting orthostatic hypotension: how long do we need to wait? Neuroepidemiology. \n                           43, 239\u2013243 (2014).","journal-title":"Neuroepidemiology."},{"key":"5668_CR25","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s10286-008-0472-1","volume":"18","author":"KA Mayuga","year":"2008","unstructured":"Mayuga, K. A., Butters, K. B. & Fouad-Tarazi, F. Early versus late postural tachycardia: a re-evaluation of a syndrome. Clin Auton Res \n                           18, 155\u2013157 (2008).","journal-title":"Clin Auton Res"},{"key":"5668_CR26","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1002\/(SICI)1097-4598(199712)20:12<1561::AID-MUS11>3.0.CO;2-3","volume":"20","author":"PA Low","year":"1997","unstructured":"Low, P. A. et al. Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle nerve. \n                           20, 1561\u20131568 (1997).","journal-title":"Muscle nerve."},{"key":"5668_CR27","first-page":"s248","volume":"21","author":"PA Low","year":"2015","unstructured":"Low, P. A. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am. J. Manag. Care. \n                           21, s248\u2013257 (2015).","journal-title":"Am. J. Manag. Care."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-05668-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-05668-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-05668-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T06:51:42Z","timestamp":1671778302000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-05668-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,18]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,12]]}},"alternative-id":["5668"],"URL":"https:\/\/doi.org\/10.1038\/s41598-017-05668-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7,18]]},"assertion":[{"value":"6 February 2017","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 June 2017","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 July 2017","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"5706"}}