A Man with Labile Blood Pressure

Abstract

Ronald Ma and colleagues discuss the differential diagnosis and management of a patient who presented with recurrent episodes of chest discomfort, palpitations, and labile blood pressure.

Baroreceptor failure related to bilateral carotid artery disease: an uncommon cause of labile hypertension

“…2 It is common for patients with baroreflex failure to have low resting blood pressure. 3 This pattern naturally presents a therapeutic challenge to clinicians, mandating frequent follow up and careful titration of antihypertensives. bs_bs_banner Letters to the Editor Clinically significant damage to the afferent limb of the baroreflex arc seems to be uncommon and largely iatrogenic in origin.…”

“…Offending procedures cited in case reports include unilateral and bilateral CEA, 4,5 carotid body tumour resection 6 and radiotherapy for throat cancer. 3,7,8 Non-iatrogenic causes are trauma, tumour growth and afferent sensory neuropathy. 2 In addition, brainstem stroke may impair function of the NTS or autonomic centres.…”

“…High-dose benzodiazepines, as well as behavioural therapy and relaxation techniques, may also be effective in preventing sympathetic surges. 2,3,14…”

Blood Pressure Lability

“…10 Their role is to buffer abrupt changes and prevent the blood pres-sure from rising or falling excessively by adjusting cardiac rate, degree of cardiac contractility, and modulation of vascular tone of the blood vessels. 11 Dip is a cardioprotective blood pressure pattern that occurs during the hours of sleep. 11 Dip is a cardioprotective blood pressure pattern that occurs during the hours of sleep.…”