Abstract
The autonomic nervous system maintains homeostasis, with the vestibulosympathetic reflex playing a key role in regulating blood pressure during postural changes. Benign paroxysmal positional vertigo (BPPV), a common vestibular disorder, has been linked to autonomic dysfunction, but the impact of vestibular-autonomic interactions on BPPV recurrence remains unclear. This prospective study investigated whether changes in diastolic blood pressure (DBP) responses during head-up tilt tests before and after treatment are associated with BPPV recurrence in 370 patients with idiopathic BPPV. DBP responses were recorded at 1 and 2 min after tilting, and patients were categorized into three groups based on DBP changes. At 6 months, the high-response group in the 1-minute DBP category had a 1.98-fold higher recurrence rate than the low-response group (p = 0.029). At 12 months, this group showed a 9.8-fold higher multiple recurrence rate (p = 0.033), while the high-response group in the 2-minute category had a 14.3-fold higher rate (p = 0.012). These results suggest that elevated DBP responses during vestibulosympathetic reflex activation are significantly associated with BPPV recurrence. Monitoring DBP through head-up tilt tests could provide valuable insights into recurrence risk, highlighting the role of vestibular-autonomic interactions in BPPV.