Published Online
on February 28, 2005

A more recent version of this article appeared on April 1, 2005

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Submitted on December 20, 2004
Revised on January 3, 2005

Management of Hypertension in the Setting of Autonomic Failure. A Pathophysiological Approach

Cyndya Shibao; Alfredo Gamboa; André Diedrich; and Italo Biaggioni^*

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

^* To whom correspondence should be addressed. E-mail: Italo.biaggioni{at}vanderbilt.edu.

Abstract--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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