Sex differences in heart rate responses to postural provocations

Katerina Hnatkova, Martina Šišáková, Peter Smetana, Ondřej Toman, Katharina M. Huster, Tomáš Novotný, Georg Schmidt, Marek Malik

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Sex differences are known in several facets of cardiac electrophysiology, mostly concerning myocardial repolarisation. In this study, heart rate and heart rate variability (HRV) responses to postural provocations were compared in 175 and 176 healthy females and males, respectively (aged 33.1 ± 9.1 years). Two different postural provocative tests with position changes supine→sitting→standing→supine and supine→standing→sitting→supine (15-min standing, 10-min other positions) were performed up to 4 times in each subject. Heart rate and heart rate variability spectral indices were measured in 5-min windows before positional changes. At supine position, females had averaged heart rate approximately 5 beats per minute (bpm) faster than males and this sex difference was practically constant during the postural changes. In both sexes, change supine→sitting and supine→standing increased heart rate by approximately 10 and 30 bpm, respectively, with no statistical differences between the sex groups. At supine baseline, females had normalised high frequency components (nHF) of HRV approximately 7% larger compared to males (p < 0.001). While the same difference in nHF was found at sitting, the change to standing position lead to significantly larger nHF reduction in females compared to males (mean changes 22.5 vs 17.2%, p < 0.001). This shows that despite similar heart rate increase, females respond to standing by more substantial shifts in cardiac sympatho-vagal modulations. This makes it plausible to speculate that the differences in autonomic reactions to stress contribute to the known sex-differences in psychosocial responses to stressful situations and to the known difference in susceptibility to ventricular fibrillation between females and males.

Original languageEnglish
Pages (from-to)126-134
Number of pages9
JournalInternational Journal of Cardiology
StatePublished - 15 Dec 2019
Externally publishedYes


  • Autonomic modulations
  • Autonomic responsiveness
  • Heart rate
  • Heart rate variability
  • Postural changes
  • Responses to stress
  • Sex differences


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