Baroreflex failure, in its most acute and complete form, is perhaps the most dramatic
of all autonomic disorders. In major referral centers, the highest blood pressures
encountered nowadays by Hypertension specialists and Autonomic specialists are often
in patients with acute baroreflex failure. Pressure surges above 300 mmHg may occur
in some individuals. But the spectrum of baroreflex failure is very broad, and includes
individuals with both orthostatic hypertension and orthostatic hypotension, surges
in heart rate, and in some cases emotional volatility. It is noteworthy that baroreflexes
may become dysfunctional if (1) the baroreceptors themselves fail, (2) if their afferent
pathways in the vagal and glossopharyngeal nerves fail, (3) if central cardiovascular
control nuclei fail, or(4) if relevant efferent nerves effecting blood pressure control
fail. Etiologies are as varied as neck injury, familial paraganglioma syndromes, neck
irradiation, familial dysautonomia, and mitochondrial disease. Clinical management
is complex, but patients are often improved by carefully tailored regimens of such
agents as methyldopa, propranolol, and benzodiazepines. In Jordan´s syndrome of selective
baroreflex failure (efferent vagus intact), bradycardia and sinus arrest may occur
during sleep, and these patient may require a pacemaker as well.
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© 2010 Published by Elsevier Inc.