Universität zu Köln

Biaggioni, Italo, Shibao, Cyndya A., Diedrich, Andre, Muldowney, James A. S., III, Laffer, Cheryl L. and Jordan, Jens (2019). Blood Pressure Management in Afferent Baroreflex Failure JACC Review Topic of the Week. J. Am. Coll. Cardiol., 74 (23). S. 2939 - 2948. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1558-3597

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Abstract

Afferent baroreflex failure is most often due to damage of the carotid sinus nerve because of neck surgery or radiation. The clinical picture is characterized by extreme blood pressure lability with severe hypertensive crises, hypotensive episodes, and orthostatic hypotension, making it the most difficult form of hypertension to manage. There is little evidence-based data to guide treatment. Recommendations rely on understanding the underlying pathophysiology, relevant clinical pharmacology, and anecdotal experience. The goal of treatment should be improving quality of life rather than normalization of blood pressure, which is rarely achievable. Long-acting central sympatholytic drugs are the mainstay of treatment, used at the lowest doses that prevent the largest hypertensive surges. Short-acting clonidine should be avoided because of rebound hypertension, but can be added to control residual hypertensive episodes, often triggered by mental stress or exertion. Hypotensive episodes can be managed with countermeasures and short-acting pressor agents if necessary. (C) 2019 by the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Biaggioni, Italo UNSPECIFIED UNSPECIFIED UNSPECIFIED Shibao, Cyndya A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Diedrich, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Muldowney, James A. S., III UNSPECIFIED UNSPECIFIED UNSPECIFIED Laffer, Cheryl L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jordan, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-124655
DOI:	10.1016/j.jacc.2019.10.027
Journal or Publication Title:	J. Am. Coll. Cardiol.
Volume:	74
Number:	23
Page Range:	S. 2939 - 2948
Date:	2019
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1558-3597
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NERVOUS-SYSTEM; BARORECEPTOR; HYPERTENSION; HYPOTENSION; STIMULATION; TACHYCARDIA; DYSFUNCTION; ACTIVATION; DIAGNOSIS; BLOCKADE Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12465