Document Detail

The diagnosis and treatment of baroreflex failure.
MedLine Citation:
PMID:  8413455     Owner:  NLM     Status:  MEDLINE    
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 tachycardia 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.
D Robertson; A S Hollister; I Biaggioni; J L Netterville; R Mosqueda-Garcia; R M Robertson
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  329     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1993 Nov 
Date Detail:
Created Date:  1993-11-18     Completed Date:  1993-11-18     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1449-55     Citation Subset:  AIM; IM    
Department of Medicine, Vanderbilt University, Nashville, TN 37232-2195.
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MeSH Terms
Baroreflex / physiology*
Blood Pressure
Catecholamines / blood
Clonidine / therapeutic use
Hypertension / diagnosis*,  drug therapy*,  physiopathology
Middle Aged
Prospective Studies
Tachycardia / physiopathology
Grant Support
Reg. No./Substance:
0/Catecholamines; 4205-90-7/Clonidine
Comment In:
N Engl J Med. 1993 Nov 11;329(20):1494-5   [PMID:  8413462 ]
N Engl J Med. 2000 Aug 24;343(8):581   [PMID:  10979787 ]

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