{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:12:27Z","timestamp":1760235147284,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T00:00:00Z","timestamp":1627084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This research was supported by the Soonchunhyang University Research Fund and a grant of the Korea Health Technology R&amp;D Project through Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health &amp; Welfare, Republic of Korea.","award":["HI19C1132"],"award-info":[{"award-number":["HI19C1132"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: We investigated whether changes in the pulse pressure (PP) reduction ratio during the head-up tilt test (HUTT) can aid in distinguishing neurogenic orthostatic hypotension (OH) from non-neurogenic OH. Methods: We enrolled consecutive patients with NOH and non-neurogenic OH between January 2015 and October 2018. We compared the Valsalva ratio, the presence or absence of late phase II and IV overshoot, the pressure recovery time, and the PP reduction ratio during HUTT between the two OH groups. Results: The expiratory\u2013inspiratory (E:I) ratio and Valsalva ratio were significantly decreased in the NOH group (p = 0.026, p &lt; 0.001, respectively). The absence of late phase II and phase IV overshoot was more frequent in the NOH group than in the non-neurogenic OH group (p = 0.001, p &lt; 0.001, respectively). The pressure recovery time was significantly prolonged in the NOH group (p &lt; 0.001), which exhibited increases in the PP reduction ratio (1\u2014minimal PP\/baseline PP) during the HUTT (p &lt; 0.001). We calculated the cutoff point for the PP reduction ratio during HUTT, which exhibited an area under the receiver operating characteristic curve of 0.766 (0.659\u20130.840, 95% confidence interval). The cutoff value for the PP reduction ratio during HUTT (0.571) exhibited sensitivity of 0.879 and specificity of 0.516. Conclusions: Increases in the PP reduction ratio during HUTT may be a meaningful NOH laboratory marker.<\/jats:p>","DOI":"10.3390\/diagnostics11081331","type":"journal-article","created":{"date-parts":[[2021,7,25]],"date-time":"2021-07-25T22:06:21Z","timestamp":1627250781000},"page":"1331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduction in Pulse Pressure during Standing Can Distinguish Neurogenic Orthostatic Hypotension"],"prefix":"10.3390","volume":"11","author":[{"given":"Kyu-On","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Neurology, Soonchunhyang University College of Medicine, Bucheon 14584, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deok-Hyun","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Soonchunhyang University College of Medicine, Bucheon 14584, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3517-8207","authenticated-orcid":false,"given":"Eek-Sung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Soonchunhyang University College of Medicine, Bucheon 14584, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6913-4689","authenticated-orcid":false,"given":"Tae-Kyeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Soonchunhyang University College of Medicine, Bucheon 14584, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,24]]},"reference":[{"key":"ref_1","first-page":"248","article-title":"Neurogenic orthostatic hypotension: Pathophysiology and diagnosis","volume":"21","author":"Low","year":"2015","journal-title":"Am. J. Manag. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1212\/01.wnl.0000184504.13173.ef","article-title":"Blood pressure recovery from Valsalva maneuver in patients with autonomic failure","volume":"65","author":"Vogel","year":"2005","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1001\/archneur.64.3.381","article-title":"Adrenergic and vagal baroreflex sensitivity in autonomic failure","volume":"64","author":"Schrezenmaier","year":"2007","journal-title":"Arch. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3233\/VES-190655","article-title":"Hemodynamic orthostatic dizziness\/vertigo: Diagnostic criteria","volume":"29","author":"Kim","year":"2019","journal-title":"J. Vestib. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/s-0033-1354598","article-title":"Vestibular neuritis","volume":"33","author":"Jeong","year":"2013","journal-title":"Semin. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3233\/VES-150549","article-title":"Diagnostic criteria for Meni\u00e8re\u2019s disease","volume":"25","author":"Carey","year":"2015","journal-title":"J. Vestib. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3233\/VES-2012-0453","article-title":"Vestibular migraine: Diagnostic criteria","volume":"22","author":"Lempert","year":"2012","journal-title":"J. Vestib. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3233\/VES-170622","article-title":"Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the B\u00e1r\u00e1ny Society","volume":"27","author":"Staab","year":"2017","journal-title":"J. Vestib. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/j.mayocp.2012.10.013","article-title":"COMPASS 31: A refined and abbreviated Composite Autonomic Symptom Score","volume":"87","author":"Sletten","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"330","DOI":"10.4065\/80.3.330","article-title":"Evaluation of orthostatic hypotension: Relationship of a new self-report instrument to laboratory-based measures","volume":"80","author":"Schrezenmaier","year":"2005","journal-title":"Mayor. Clin. Proc."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Novak, P. (2011). Quantitative autonomic testing. J. Vis. Exp., 2502.","DOI":"10.3791\/2502-v"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1212\/01.wnl.0000324625.00404.15","article-title":"Second consensus statement on the diagnosis of multiple system atrophy","volume":"71","author":"Gilman","year":"2008","journal-title":"Neurologym"},{"key":"ref_13","first-page":"10","article-title":"Progressive orthostatic hypotension in the elderly","volume":"5","author":"Brignole","year":"2006","journal-title":"E-J. Cardiol. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"280","DOI":"10.17340\/jkna.2018.4.2","article-title":"Pitfalls in the Diagnosis of Vertigo","volume":"36","author":"Kim","year":"2018","journal-title":"J. Korean Neurol. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/S0735-1097(01)01108-1","article-title":"Pulse pressure-a review of mechanisms and clinical relevance","volume":"37","author":"Dart","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3988\/jcn.2015.11.3.220","article-title":"Orthostatic Hypotension: Mechanisms, Causes, Management","volume":"11","author":"Low","year":"2015","journal-title":"J. Clin. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1213\/ANE.0b013e3182124c0e","article-title":"The physiologic implications of isolated alpha(1) adrenergic stimulation","volume":"113","author":"Thiele","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_19","first-page":"199","article-title":"Hemodynamic effects of beta adrenergic receptor stimulant and blockade. Hemodynamic effects of isoproterenol after propranolol","volume":"34","author":"Fukuta","year":"1972","journal-title":"Nagoya J. Med. Sci."},{"key":"ref_20","first-page":"336","article-title":"Autoregulation of cardiac output is overcome by adrenergic stimulation in the anaconda heart","volume":"220","author":"Joyce","year":"2017","journal-title":"J. Exp. Biol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s10286-019-00598-9","article-title":"Autonomic uprising: The tilt table test in autonomic medicine","volume":"29","author":"Cheshire","year":"2019","journal-title":"Clin. Auton. Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kim, H.A., Low, P., Sletten, D., Suarez, M., Sandroni, P., Fealey, R., Coon, E., and Singer, W. (2017). Neurogenic Versus Non-neurogenic Orthostatic Hypotension\u2013Practical Predictors for the Office (P5. 323), AAN Enterprises.","DOI":"10.1212\/WNL.88.16_supplement.P5.323"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1002\/ana.25170","article-title":"Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies","volume":"83","author":"Kaufmann","year":"2018","journal-title":"Ann. Neurol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/8\/1331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:34:30Z","timestamp":1760164470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/8\/1331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,24]]},"references-count":23,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["diagnostics11081331"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11081331","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2021,7,24]]}}}