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(Hypertension. 2005;45:469.)
© 2005 American Heart Association, Inc.

Hypertension Grand Rounds

Management of Hypertension in the Setting of Autonomic Failure

A Pathophysiological Approach

From Division of Clinical Pharmacology, Department of Medicine and Pharmacology, and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, Tenn.

Correspondence to Italo Biaggioni, MD, 1500 21st Avenue South, suite 3500, Clinical Trials Center, Vanderbilt University, Nashville, TN 37212. E-mail Italo.biaggioni{at}vanderbilt.edu

We discuss 2 cases presenting clinically with disabling orthostatic hypotension and severe supine hypertension. This is a common presentation of autonomic failure, and one that challenges conventional treatment. Clinical findings of isolated autonomic failure were the most prominent manifestation in case 1, whereas a movement disorder was the key finding in case 2. The differential diagnosis and treatment of orthostatic hypotension is discussed from a pathophysiological approach. Understanding of the underlying mechanisms of disorders of the autonomic nervous system is fundamental for an effective management of these patients and provides insight into more common disorders such as essential hypertension.

Key Words: atrophy • autonomic nervous system • hypertension • hypotension

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