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Updated: Jul 6, 2026
Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Physiologic neurocirculatory patterns in the head-up tilt test in children with orthostatic intolerance
Zhang Qingyou1, Sumou I Karmane, Du Junbao
1Department of Pediatrics, Peking University First Hospital, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China.
Insights
In children with orthostatic intolerance (OI), the head-up tilt (HUT) test revealed that vasovagal response was the most common finding, followed by postural orthostatic tachycardia.
Area of Science:
- Pediatric Cardiology
- Autonomic Nervous System Disorders
- Clinical Physiology
Background:
- Orthostatic intolerance (OI) is a frequent condition in pediatric patients.
- The head-up tilt (HUT) test is the standard for assessing orthostatic responses.
- The precise physiological neurocirculatory patterns during HUT in children with OI remain incompletely understood.
Purpose of the Study:
- To investigate the specific physiological patterns observed during HUT testing in children diagnosed with OI.
- To elucidate the neurocirculatory responses associated with OI in a pediatric cohort.
Main Methods:
- Ninety children (mean age 11.6 years) with OI participated in the study.
- Participants underwent HUT testing under controlled, quiet conditions.
- Continuous monitoring of blood pressure and heart rate was performed throughout the HUT procedure.
Main Results:
- Vasovagal response was identified in 54.4% of children with OI during HUT.
- Postural orthostatic tachycardia was observed in 31.1% of the participants.
- Vasodepressor response (36.7%), cardioinhibitory response (6.7%), and mixed responses (11.1%) were also noted, alongside one case of orthostatic hypotension (1.1%).
Conclusions:
- The predominant physiological pattern in children with OI during HUT testing is the classical vasovagal response.
- Postural orthostatic tachycardia represents the second most frequent physiological response observed in this pediatric population.
Background:
Orthostatic intolerance (OI) is a common clinical manifestation in clinical pediatrics. The head-up tilt (HUT) table test is considered the standard of orthostatic assessment, but the physiologic neurocirculatory profile during HUT has not been fully realized in children with OI. The present study, therefore, was designed to investigate the physiologic patterns that occur during HUT in children with OI.
Methods:
Ninety children (56 girls; mean age, 11.6 +/- 2.3 years) with OI underwent HUT under quiet circumstances. Blood pressure and heart rate were monitored simultaneously.
Results:
Forty-nine children with OI (54.4%) had vasovagal response with HUT testing; 33 (36.7%), vasodepressor response; six (6.7%), cardioinhibitory response; and 10 (11.1%), mixed response. Twenty-eight children (31.1%) had postural orthostatic tachycardia; one (1.1%), orthostatic hypotension (OH); and 12 (13.3%), normal physiologic response. Patterns of cerebral syncope response and chronotropic incompetence were not observed.
Conclusions:
Classical vasovagal response was the major physiologic pattern seen in children with OI during HUT testing, and postural orthostatic tachycardia response ranked second.
