Management of hypertension in the setting of autonomic failure: a pathophysiological approach.
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.
Shibao
Cyndya
C
Division of Clinical Pharmacology, Department of Medicine and Pharmacology, and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, Tenn 37212, USA.
Gamboa
Alfredo
A
Diedrich
André
A
Biaggioni
Italo
I
D000368:Aged; D000369:Aged, 80 and over; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D007024:Hypotension, Orthostatic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D016683:Supine Position