Can sinoaortic baroreceptor heart rate reflex sensitivity be determined from phase IV of the Valsalva manoeuvre?

A new time related method of analysing the sinoaortic baroreceptor heart rate reflex, which determines reflex latency as well as sensitivity, was used to compare the results obtained with a phenylephrine ramp method (P) with those obtained using the whole of phase IV of Valsalva (V1) and using the phase IV systolic blood pressure overshoot alone (V2). Twenty five subjects with large ranges of age and resting blood pressures were studied. Each performed two standardised Valsalva manoeuvres and received three bolus injections of phenylephrine sufficient to cause transient pressor responses of 20-30 mmHg. Mean sensitivity values with P (6.2(3.5) ms.mmHg-1) were greater than those with V1 (4.6(2.3) ms.mmHg-1, p less than 0.001) and less than V2 (7.8(4.0) ms.mmHg-1, p less than 0.001). However, linear regression analysis showed a correlation of P with V1 (r = 0.76, p less than 0.0001) and with V2 (r = 0.80, p less than 0.0001). Reflex latency with P (1084(427) ms) was less than V1 (2416(423) ms, p less than 0.0001) and V2 (1504(441) ms, p less than 0.0005). Reflex sensitivity results obtained using phase IV of Valsalva's manoeuvre are proportionately related to phenylephrine results, but large errors were introduced into the absolute values obtained when relatively small changes were made to the method of analysis.