Determinants of a positive response to carotid sinus massage and head-up tilt testing.
BACKGROUND
Orthostatic hypotension (OH) and carotid sinus hypersensitivity (CSH) are common causes of syncope in older people. The aim of this study was to determine if patient's age, sex and presenting symptoms influence the result of carotid sinus massage and head-up tilt testing.


METHODS
Retrospective analysis of the database and reports was carried out between 1995 and 2006 at a tertiary referral centre. Patient's age, sex, presenting symptoms and test result were examined. Presenting symptoms were classified as syncope, falls or dizzy spells.


RESULTS
Of the 1583 tests reported, OH was present in 402 patients (25.4%), of whom 175 (11.1%) were symptomatic. 188 of 1464 (12.8%) patients undergoing carotid sinus massage had evidence of CSH, of which 156 were symptomatic. Male patients were significantly more likely to have symptomatic CSH than female patients (odds ratio 2.28, 95% CI 1.54 to 3.04, p<0.01). There were non-significant trends to increased diagnosis of symptomatic OH with increasing age, male sex and referral with syncope. There were non-significant trends to increased diagnosis of symptomatic CSH with increasing age and referral with syncope.


CONCLUSIONS
Male sex, increasing age and being referred with syncope were all associated with an increased likelihood of receiving a diagnosis of either OH or CSH. The overall prevalence of CSH was lower than in previous studies, which may reflect different patient populations.
Milton
James C
JC
Department of Ageing and Health, St Thomas Hospital, London, United Kingdom. jim_milton@hotmail.com
Lee
Thomas C
TC
Jackson
Stephen H D
SH
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002346:Carotid Sinus / Q000503:physiopathology*; D004244:Dizziness / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008405:Massage; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D013575:Syncope / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D018667:Tilt-Table Test / Q000379:methods*