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(Hypertension. 2005;45:834.)
© 2005 American Heart Association, Inc.

Hypertension Grand Rounds

Baroreflex Failure

From the Franz-Volhard Clinical Research Center, Medical Faculty of the Charité and Helios Klinikum, Berlin, Germany.

Correspondence to Jens Jordan, MD, Franz-Volhard Clinical Research Center, Haus 129 Wiltbergstr. 50 13125 Berlin, Germany. E-mail jordan{at}fvk.charite-buch.de

The baroreflex receives less attention nowadays because most students of hypertension are convinced that faulty volume regulation by the kidneys is responsible for long-term blood pressure increases. However, unusual patients with bilateral destruction of the normal blood pressure–sensing mechanisms can develop profound chronic hypertension. We present 2 patients with baroreflex failure. Both had volatile hypertension with systolic readings up to 300 mm Hg documented over years. Both had muscle sympathetic nerve activity that was increased even while resting. Treating these patients was a stochastic challenge. The therapy is frequently based on medicines that are no longer commonly prescribed.

Key Words: baroreflex • sympathetic nervous system • autonomic nervous system • hypotension • bradycardia