Normative data on phases of the Valsalva maneuver

The phases of the Valsalva maneuver have well-known pathophysiology, and are used in the evaluation of adrenergic function. Because scant normative data is available, we have evaluated normative data for the Valsalva maneuver in control subjects. The patient, supine, performed the Valsalva maneuver maintaining an expiratory pressure of 40 mm Hg for 15 seconds. We reviewed 188 Valsalva maneuver recordings of normal control subjects, and recordings were excluded if two reproducible recordings were not obtained, or if expiratory pressure was <30 mm Hg or <10 seconds. One hundred and three recordings were acceptable for analysis; 47 female and 56 male subjects, age in years (mean ± SD) was 52.2 ± 17.3 and 44.8 ± 17.3, respectively. The association of expiratory pressure with age (P < 0.001) and gender (P < 0.001) was complex, expressed as a parabola in both men and women, but resulted in phases I and III that were not significantly different. An increase in age resulted in a progressively more negative phase II-E (P < 0.05) and attenuation of phase II-L (P < 0.01). An increase in supine blood pressure resulted in a significantly more negative phase EII-E (P < 0.001) and a lower phase IV. Phase IV is unaffected by age and gender.