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Figure 3 A case of control and active handgrip (HG) tilting in the same patient. The top trace shows the heart rate (HR) curve; the bottom trace shows systolic, diastolic, and mean blood pressure (BP) curves. Right panel, control. The pattern was that of a typical tilt-induced vasovagal reaction, with hypotension and bradycardia. The arrow indicates the time of onset of symptoms of impending syncope, when placebo HG was administered. Subsequently, BP and HR continued to fall and the patient suffered syncope after 45 s. Left panel, active treatment. Initially, the pattern of BP and HR was similar to that observed in the control study. The start of HG caused a rapid rise in BP, which persisted as long as the contraction was maintained; initially, HR slightly increased and then slightly decreased; symptoms disappeared. During the recovery phase, SBP fell again to 90 mm Hg and symptoms reappeared.