Output limb
Efferent · autonomic failure
The output limb. Vessels fail to defend BP. Typical: nOH, often little HR rise, supine hypertension, rebound when flat. A modest HR rise does not move the case off this shelf.
Clinical orientation for orthostatism (prolonged standing). The assessment helps us classify baroreflex dysfunction as afferent or efferent; both diagnoses are different limbs — the atlas keeps them on separate shelves, which helps us think about functional or degenerative baroreflex conditions.
How to perform the assessment
Santa Fe stand (15–20–5–2)
15
1st supine
20
Standing
05
2nd supine
02
Sitting
Marks at standing minutes 3 and 10 (nOH).
Sample row — standing minute 3
- Position / comments
- Standing
- Time
- 3
- SBP
- 92
- MBP
- 70
- DBP
- 58
- HR
- 72
- Position / comments
Write Supine, Standing, Sitting, or an event (talk / pain / grab free hand). Keep recording.
- Time
Minute of that position. Standing 3 and 10 are the nOH marks.
- SBP · DBP · HR
Systolic, diastolic (mmHg) and pulse (bpm). If the cuff marks an error, write 0 — never leave the cell empty.
- MBP
Mean BP. Optional on the phone; the reader can compute it.
- 01
1st supine — continuous BP and pulse, lying down, 15 minutes.
- 02
Passive standing — the person stands up; keep reading 20 minutes. Minutes 3 and 10 are the nOH marks.
- 03
2nd supine — back lying down, 5 minutes.
- 04
Sitting — BP and pulse, 2 minutes.
- 05
If the patient talks, feels pain, or grabs the free hand, please continue recording and put an observation about the action he/she was doing in the commentaries section of the Baroreflex sheet.
- 06
Fill the Survey sheet: pick No, Past, or Current for every condition they have had or have now. The survey lives in the same workbook as the BaroSheet so history and the trace are one record.
One row = one minute. If the cuff marks an error, write 0 in the cell; never leave the cell empty. Position words: Supine · Standing · Sitting.
No computer? Fill on this phoneDigital BaroSheet — type SBP, DBP and pulse minute by minute. Same 15–20–5–2 protocol.Survey — conditions they had or have now
Pick No / Past / Current. Saved with this visit. Download writes those picks to Excel (also the Survey tab of BaroSheet). The stand is still read first; history orients, it does not recode the shelf.
Neurodegenerative / synucleinopathy
- Parkinson’s disease
- Other degenerative parkinsonism
- Multiple system atrophy
- Dementia with Lewy bodies
- Pure autonomic failure
- Huntington’s disease
- Normal-pressure hydrocephalus
- Ataxia
- Adult-onset leukodystrophy
Autonomic syndromes
- Neurogenic orthostatic hypotension
- POTS
- Vasovagal / neurally mediated syncope
- Neurogenic hypertension
- Labile episodic hypertension
- Secondary paroxysmal neurogenic hypertension
- Autoimmune autonomic ganglionopathy
- Other dysautonomia
Associated conditions
- Hypermobile spectrum
- Small fiber neuropathy
- Fibromyalgia
- Difficult-to-control migraine
- Functional neurological disorder
- Adenomyosis
History that changes the reading
- After an infection
- Autoimmune disease
- Neck surgery
- Carotid endarterectomy / neck vascular surgery
- Neck cancer or radiation
- Pressor medication
Who can have this assessment
Children, adolescents, and adults — when dysautonomia is suspected.
Use the prolonged passive stand when the visit raises a specific suspicion, not as a general checkup. It diagnoses baroreflex dysfunction as nOH, non-neurogenic OH, POTS, vasovagal, or labile hypertension. It does not treat.
Who
- Children
- Adolescents
- Adults
- After an infection
- Synucleinopathies
- Autoimmunity
- No cause yet
Neurodegenerative / synucleinopathy
- Parkinson’s disease
- Other degenerative parkinsonisms
- Multiple system atrophy
- Dementia with Lewy bodies
- Pure autonomic failure
- Huntington’s disease
- Normal-pressure hydrocephalus
- Ataxias
- Adult-onset leukodystrophies
Autonomic syndromes
- Neurogenic orthostatic hypotension
- POTS
- Neurally mediated vasovagal syncope
- Neurogenic hypertension
- Labile episodic hypertension
- Secondary paroxysmal neurogenic hypertension
- Autoimmune autonomic ganglionopathy
- Other dysautonomias
Associated conditions and symptoms
- Hypermobile spectrum
- Small fiber neuropathy
- Fibromyalgia
- Difficult-to-control migraine
- Functional neurological disorders
- Adenomyosis
- Lightheadedness on standing
- Fatigue, palpitations, poor exercise tolerance, brain fog
Indications follow Centro Santa Fe: autonomiaclinicsf.com. Clinical orientation for orthostatism (prolonged standing). The assessment helps us classify baroreflex dysfunction as afferent or efferent; both diagnoses are different limbs — the atlas keeps them on separate shelves, which helps us think about functional or degenerative baroreflex conditions.
Two limbs, not one pattern
Sensing limb
Afferent · baroreflex spectrum
The sensing / buffering limb. HR can still fire. Includes POTS (sustained HR +≥30), labile episodic hypertension, vasovagal syncope. Do not call these autonomic failure.
Reference
Intact
Flat 60° tilt, modest HR, clean pressor, return to baseline.
Consensus definitions
Labels from the literature, used to diagnose afferent vs efferent baroreflex dysfunction. This does not treat.
Neurogenic OH (nOH)
Not met on this traceSustained SBP drop ≥20 mmHg or DBP drop ≥10 mmHg within 3 minutes of standing, with inadequate HR rise <15 bpm.
Non-neurogenic OH
Not met on this traceThe same BP criteria within 3 minutes of standing, with an appropriate HR rise ≥15 bpm.
Delayed OH
Not met on this traceThe same BP criteria (SBP drop ≥20 or DBP drop ≥10) first occurring after 3 minutes of standing.
Afferent baroreflex dysfunction
This visit meetsSensing / buffering failure, not an output failure. Includes vasovagal (neurally mediated) syncope — BP and HR falling together — and labile episodic hypertension with pressor bursts to speech, pain, or grasp. Neck surgery, carotid endarterectomy, or neck cancer/radiation point to acquired afferent baroreflex failure; without that history the same patterns are the functional end of the spectrum (POTS, vasovagal, labile HTN). These are not autonomic failure.
Neurogenic supine hypertension
Not met on this traceSupine SBP ≥140 mmHg and/or DBP ≥90 mmHg in the presence of autonomic failure.
References
- Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope, and postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72.
- Idiaquez JF, Idiaquez J, Casar JC, Biaggioni I. Neurogenic orthostatic hypotension. Lessons from synucleinopathies. Am J Hypertens. 2021;34(2):125-133.
- Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567-1582.
Pilot on the Centro Santa Fe subdomain. Diagnoses afferent vs efferent baroreflex dysfunction. Does not treat. Files stay in this browser. No charge on this probe.
Atlas
Healthy reference
Intact
Protocol numbers
Santa Fe stand (15–20–5–2) · 36 min
Santa Fe stand: 15 min 1st supine → 20 min passive standing → 5 min 2nd supine → 2 min sitting. If the patient talks, feels pain, or grabs the free hand, keep recording and note the action in comments.
SBP 1st supine
118
SBP stand
126
Δ tilt − supine SBP
+8
Δ tilt − supine HR
+1
Nadir ΔSBP
-3
Peak ΔHR
+5
ΔHR / |ΔSBP|
—
Return − supine
+1
3 min stand
ΔSBP
+3
ΔHR
+3
ΔHR/|ΔSBP|
—
Neurogenic
—
10 min stand
ΔSBP
-1
ΔHR
+1
ΔHR/|ΔSBP|
—
Neurogenic
—
Three pictures — no overlap
Same BP and HR scales on all three. Read each trace on its own.
- SBP
- DBP
- HR
1 · Healthy
Ref · Healthy reference
ΔSBP +7.5 · ΔHR +1.1
- Body position
- 1st supine
- Head-up tilt
- 2nd supine
- Sitting
2 · Atlas example
Case 3 · Case 3 example
ΔSBP -68.0 · ΔHR +7.3
- Body position
- 1st supine
- Head-up tilt
- 2nd supine
- Sitting
3 · This case
Healthy reference
ΔSBP +7.5 · ΔHR +1.1
- Body position
- 1st supine
- Head-up tilt
- 2nd supine
- Sitting
Teaching shelves
60 teaching cases. Send the next workbook with the shelf (efferent · afferent · POTS · vasovagal · healthy). Added as Case N — no names.