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Previous Volume 329:1449-1455 November 11, 1993 Number 20 Next

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ABSTRACT

Background Baroreflexes originate in the great vessels of the neck and thorax and prevent arterial pressure from rising or falling excessively.

Methods This study was undertaken to clarify the cause, clinical spectrum, and therapy of this disorder. We studied 11 patients with baroreflex failure presenting as severe, labile hypertension and hypotension, often with headache, diaphoresis, and emotional instability, and characterized by the failure of exogenous vasoactive substances to alter heart rate. Each underwent hemodynamic monitoring and biochemical, physiologic, and pharmacologic testing.

Results The patients' maximal systolic blood pressures ranged from 164 to 280 mm Hg, and their minimal systolic pressures ranged from 58 to 96 mm Hg. Plasma norepinephrine and epinephrine concentrations were sometimes many times normal during blood-pressure surges. All the patients had excessive pressor and tachycardic responses to the mental-arithmetic and cold pressor tests and marked hypersensitivity to clonidine. The underlying causes of baroreflex failure included the familial paraganglioma syndrome, neck surgery or radiation therapy for pharyngeal carcinoma, bilateral lesions of the nucleus tractus solitarii, and surgical section of the glossopharyngeal nerves; in two patients the cause was unknown. Therapy with clonidine reduced the frequency of attacks by 81 percent and attenuated the elevated blood pressure and heart rate in the attacks that occurred.

Conclusions The syndrome of baroreflex failure should be considered in patients with otherwise unexplained labile hypertension. Clonidine attenuates the pressor and tachycardic surges in baroreflex failure.

Source Information

From the Departments of Medicine (D.R., I.B., R.M.-G., R.M.R.), Pharmacology (D.R., I.B., R.M.-G.), Neurology (D.R.), and Otolaryngology (J.L.N.), Autonomic Dysfunction Center, Vanderbilt University, Nashville; and the Division of Clinical Pharmacology, University of Colorado Health Sciences Center, Denver (A.S.H.).

Address reprint requests to Dr. David Robertson at AA3228 MCN, Autonomic Dysfunction Center, Vanderbilt University, Nashville TN 37232-2195.

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