Conclusion
This randomised placebo-controlled study is the first to assess HOT in patients aged >65 years with VVS using serial autonomic cardiovascular reflex measures. There were no improvements in these autonomic measures in any of our study groups. The lack of efficacy in the elderly population may relate to the degeneration of the autonomic nervous system not responding to physical countermeasures. These findings do not support the use of HOT in the elderly population.