Document Detail


The diagnosis and treatment of baroreflex failure.
MedLine Citation:
PMID:  8413455     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
D Robertson; A S Hollister; I Biaggioni; J L Netterville; R Mosqueda-Garcia; R M Robertson
Related Documents :
1120965 - Studies concerning the mechanism of suppression of renin secretion by clonidine.
22938375 - An approach to determine pressure profile generated by compression bandage using quasi-...
1383835 - Cp-96,345, a non-peptide antagonist of substance p: ii. actions on substance p-induced ...
23677855 - Social adversity experience and blood pressure control following antihypertensive medic...
7527105 - Effects of trandolapril on 24-h ambulatory blood pressure in patients with mild-to-mode...
20123095 - Comparative effects of captopril and l-carnitine on blood pressure and antioxidant enzy...
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    
Affiliation:
Department of Medicine, Vanderbilt University, Nashville, TN 37232-2195.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Baroreflex / physiology*
Blood Pressure
Catecholamines / blood
Clonidine / therapeutic use
Female
Humans
Hypertension / diagnosis*,  drug therapy*,  physiopathology
Male
Middle Aged
Prospective Studies
Syndrome
Tachycardia / physiopathology
Grant Support
ID/Acronym/Agency:
HL37961/HL/NHLBI NIH HHS; HL44589/HL/NHLBI NIH HHS; RR00095/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Catecholamines; 4205-90-7/Clonidine
Comments/Corrections
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 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Age-related increase in mortality among patients with first myocardial infarctions treated with thro...
Next Document:  The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative St...