Paroxysmal hypertension due to baroreflex failure

Zar, Tausif; Peixoto, Aldo J.

doi:10.1038/ki.2008.30

Cited by 25 publications

(13 citation statements)

References 22 publications

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“…11,21 Second, in animal models of baroreceptor deafferentation, which results in a cardiovascular phenotype startlingly similar to the FD phenotype, the extent of end organ target damage is directly related to the degree of blood pressure variability. 22 Finally, and particularly relevant for patients with FD, CKD has been reported in patients who have paroxysmal hypertension and surges in circulating catecholamines caused by damage to the afferent baroreflex pathways after radiation therapy to the neck 23 or as a result of a pheochromocytoma. 24,25 …”

Section: Discussionmentioning

confidence: 99%

Developmental abnormalities, blood pressure variability and renal disease in Riley Day syndrome

2011

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Riley Day syndrome, commonly referred to as familial dysautonomia (FD), is a genetic disease with extremely labile blood pressure due to baroreflex deafferenation. Chronic renal disease is very frequent in these patients and was attributed to recurrent arterial hypotension and renal hypoperfusion. Aggressive treatment of hypotension, however, has not reduced its prevalence. We evaluated the frequency of kidney malformations as well as the impact of hypertension, hypotension and blood pressure variability on the severity of renal impairment. We also investigated the effect of fludrocortisone treatment on the progression of renal disease. Patients with FD appeared to have an increased incidence of hydronephrosis/reflux and patterning defects. Patients younger than 4 years old had hypertension and normal eGFR. Patients with more severe hypertension and greater variability in their blood pressure had worse renal function (both, p<0.01). In contrast, there was no relationship between eGFR and the lowest blood pressure recorded during upright tilt. The progression of renal disease was faster in patients receiving fludrocortisone (p<0.02). Hypertension precedes kidney disease in these patients. Moreover, increased blood pressure variability as well as mineralocorticoid treatment accelerate the progression of renal disease. No association was found between hypotension and renal disease in patients with FD.

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Section: Discussionmentioning

confidence: 99%

Developmental abnormalities, blood pressure variability and renal disease in Riley Day syndrome

2011

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“…The carotid baroreflex is responsible for making adjustments to BP on a continuous minute-by-minute basis to prevent excessive rises and falls. The Rheos Baroreflex Hypertension Therapy System would help carotid sinuses itself to enhance the afferent nerve outflow from the baroreceptors to the cardiovascular control centers of the brain to produce the cancellated effect, which decreases heart rate (HR), myocardium contractility, vascular tone and increases the natriuresis to lower the arterial pressure [24,25]. The efficiency and safety were evaluated by a hypertension trial (DEBuT-HT) [26] conducted by a consortium of nine European institutions.…”

Section: ) Renal Denervation (Rdn)-a Controversial Methodmentioning

confidence: 99%

Progression in Diagnosis and Treatment of Resistant Hypertension

He¹,

Mu²,

Liu³

et al. 2014

J Cardiovasc Med Cardiol

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Introduction: Resistant Hypertension (RH) is a major risk factor of numerous diseases. RH is a challenging clinical problem,many factors affect blood pressure (BP) control. Correct diagnosis and appropriate drug therapy are pretty important to get BP controlled. We aim to attract physicians' attention to adopt correct measures to diagnose and treat RH.Method: Articlesare obtained from the Internet, www.pubmed.com, Medline and several authors via e-mail.Result and Conclusion: 1.Using a systematic approach to find out the causes of RH and the distinctions between pseudo-resistance and true resistance areof importance for treatment. 2. Following the current treatment guidelines and using the standardized way to establish a flowchart to manage the patientsare the correct methods for BP control. 3. In the absence of novel antihypertensive drugs targeting new pathways, device-based therapies including RDN, carotid baroreflex activation and continuous positive airway pressure (CPAP) have shown encouraging results. 4. Further efforts on the pathophysiology of RH will help to establish better drug combinations or new ways on BP control. and treatment of RH to attract physicians' attention to adopt correct measures to diagnose and treat RH. Discussion PrevalenceStrictly speaking, RH is not a definition of disease, but of management. So it is difficult to get its correct prevalence. Because of this, its prevalence is still unclear. Some large-scale clinical trials intended to figure out the prevalence of RH in overall population and hypertensive populationare shown below.According to the latest data from ESH/ESC [1], the prevalence of RH is around 5%-30% of the overall hypertensive populationwithfigures less than 10% probably representing the true prevalence. Arepresentative survey carried out by American National Health and Nutrition Examination [2] including > 15 000 non-pregnant adults between 2003 and 2008 found that resistant hypertension criteria were met in 8.9% of all individuals with hypertension, and in 12.8% of the hypertensive drugs treated population. A complete database for 7.9 years from Olivetti Heart Study (OHS) in southern Italy [3] showed that the prevalence of RH was 4.8% in the whole study population, and 10.1% in hypertensive participants. It seems that the prevalence ofRHis around 10% in hypertensive population, butsituations including treatment adherence, white coat hypertension and secondary hypertension were not reported. Another more detailed research by Stacie et al [4] demonstrated thatafter the exclusion of those who lost baseline data or failed to adhere to the research, the inadequate number of antihypertensive drugs, and poor medication adherence,the prevalence of true RH was only 1.9%among 205750 patients. It is, Abbreviations

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“…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.…”

Section: Baroreceptor Failure Related To Bilateral Carotid Artery Dismentioning

confidence: 99%

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

Hayat

Whittam

2014

Internal Medicine Journal

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Paroxysmal hypertension due to baroreflex failure

Cited by 25 publications

References 22 publications

Developmental abnormalities, blood pressure variability and renal disease in Riley Day syndrome

Developmental abnormalities, blood pressure variability and renal disease in Riley Day syndrome

Progression in Diagnosis and Treatment of Resistant Hypertension

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

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