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Blood pressure management in afferent baroreflex failure: JACC review topic of the week

Biaggioni, I. and Shibao, C.A. and Diedrich, A. and Muldowney 3rd., James A.S. and Laffer, C. L. and Jordan, J. (2019) Blood pressure management in afferent baroreflex failure: JACC review topic of the week. Journal of the American College of Cardiology, 74 (23). Elsevier. DOI: 10.1016/j.jacc.2019.10.027 ISSN 0735-1097

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Abstract

Afferent baroreflex failure is most often due to damage of the carotid sinus nerve because of neck surgery or radiation. The clinical picture is characterized by extreme blood pressure lability with severe hypertensive crises, hypotensive episodes, and orthostatic hypotension, making it the most difficult form of hypertension to manage. There is little evidence-based data to guide treatment. Recommendations rely on understanding the underlying pathophysiology, relevant clinical pharmacology, and anecdotal experience. The goal of treatment should be improving quality of life rather than normalization of blood pressure, which is rarely achievable. Long-acting central sympatholytic drugs are the mainstay of treatment, used at the lowest doses that prevent the largest hypertensive surges. Short-acting clonidine should be avoided because of rebound hypertension, but can be added to control residual hypertensive episodes, often triggered by mental stress or exertion. Hypotensive episodes can be managed with countermeasures and short-acting pressor agents if necessary.

Item URL in elib:https://elib.dlr.de/133081/
Document Type:Article
Title:Blood pressure management in afferent baroreflex failure: JACC review topic of the week
Authors:
AuthorsInstitution or Email of AuthorsAuthors ORCID iD
Biaggioni, I.Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, NashvilleUNSPECIFIED
Shibao, C.A.Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee;UNSPECIFIED
Diedrich, A.Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TennesseeUNSPECIFIED
Muldowney 3rd., James A.S.Department of Medicine, Vanderbilt University Medical Center, Nashville, TennesseeUNSPECIFIED
Laffer, C. L.Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TennesseeUNSPECIFIED
Jordan, J.Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Jens.Jordan (at) dlr.dehttps://orcid.org/0000-0003-4518-0706
Date:2 December 2019
Journal or Publication Title:Journal of the American College of Cardiology
Refereed publication:Yes
Open Access:No
Gold Open Access:No
In SCOPUS:Yes
In ISI Web of Science:Yes
Volume:74
DOI :10.1016/j.jacc.2019.10.027
Publisher:Elsevier
ISSN:0735-1097
Status:Published
Keywords:autonomic nervous System; baroreflex; carotid Sinus; Hypertension; orthostatic hypotension
HGF - Research field:Aeronautics, Space and Transport
HGF - Program:Space
HGF - Program Themes:Research under Space Conditions
DLR - Research area:Raumfahrt
DLR - Program:R FR - Forschung unter Weltraumbedingungen
DLR - Research theme (Project):R - Vorhaben Systemphysiologie
Location: Köln-Porz
Institutes and Institutions:Institute of Aerospace Medicine
Deposited By: Schrage, Larissa
Deposited On:16 Jan 2020 12:32
Last Modified:16 Jan 2020 12:32

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