A higher proportion of men than of women fainted in the phase without nitroglycerin in tilt-induced vasovagal syncope

Maryam Ghariq, Roland D. Thijs, L. Martine Bek, Erik W. van Zwet, David G. Benditt, J. Gert van Dijk

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: Vasovagal syncope (VVS) affects more women than men. We determined whether this sex ratio affects tilt table test (TTT) results. Methods: We retrospectively studied TTT outcomes in suspected VVS. TTT consisted of supine rest, a maximum 20 min of head-up tilt without and, if nitroglycerin was needed, a further maximum 20 min after nitroglycerin administration. TTT was terminated if VVS occurred. We used binary logistic regression for the entire TTT and for each phase, with VVS as outcome and age and sex as predictors. Results: TTT provoked vasovagal (pre)syncope in 494 out of 766 tests (64%). The proportion of men and women who fainted during the entire TTT did not differ significantly between the sexes (p = 0.13, corrected for age). A lower proportion of women than men had VVS in the phase without nitroglycerin (odds ratio 0.54; 95% confidence interval 0.37–0.79; p = 0.002, corrected for age), whereas a higher proportion of women than men fainted after nitroglycerin (odds ratio 1.58; 95% confidence interval 1.13–2.21; p = 0.008, corrected for age). These sex differences remained significant after correction for a history of orthostatic versus emotional triggers. The effect of sex on TTT outcome was closely associated with differences of blood pressure change upon tilt-up (lower in men in both TTT phases: without nitroglycerin p = 0.003; with nitroglycerin p = 0.05), but not with heart rate changes. Conclusion: Men were more susceptible to induction of VVS without nitroglycerin and women after it. The unexpected findings may be due to sex-specific pathophysiological differences.

Original languageEnglish (US)
Pages (from-to)441-447
Number of pages7
JournalClinical Autonomic Research
Issue number5
StatePublished - Oct 1 2020

Bibliographical note

Funding Information:
This study was funded by the Netherlands Organization for Health Research and Development (843002707).

Funding Information:
M. Ghariq, LM. Bek, and EW. van Zwet report no disclosures relevant to the manuscript. J.G. van Dijk has received lecture fees from Medtronic. Dr. Benditt has received consulting fees from Medtronic plc and Zoll Medical Corporation. R.D. Thijs has received funding from Medtronic and fees for lectures from Medtronic, UCB, and GSK. R.D. Thijs receives research support from the Dutch National Epilepsy Fund, The Netherlands Organisation for Health Research and Development (ZonMW; 843002707), NUTS Ohra Fund, Medtronic, Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie, The Netherlands and AC Thomson Foundation.

Publisher Copyright:
© 2020, The Author(s).


  • Fainting
  • Nitroglycerin
  • Sex
  • Tilt table testing
  • Vasovagal syncope


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