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Blood Pressure Management in Afferent Baroreflex Failure
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2019-12-01 , DOI: 10.1016/j.jacc.2019.10.027 Italo Biaggioni 1 , Cyndya A Shibao 2 , André Diedrich 2 , James A S Muldowney 3 , Cheryl L Laffer 4 , Jens Jordan 5
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2019-12-01 , DOI: 10.1016/j.jacc.2019.10.027 Italo Biaggioni 1 , Cyndya A Shibao 2 , André Diedrich 2 , James A S Muldowney 3 , Cheryl L Laffer 4 , Jens Jordan 5
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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.
中文翻译：
传入压力反射衰竭的血压管理
传入压力反射衰竭最常见的原因是颈部手术或放疗导致颈动脉窦神经受损。临床表现的特点是血压极度不稳定，伴有严重的高血压危象、低血压发作和体位性低血压，使其成为最难控制的高血压形式。指导治疗的循证数据很少。建议依赖于对潜在病理生理学、相关临床药理学和轶事经验的了解。治疗的目标应该是改善生活质量，而不是使血压正常化，而这是很难实现的。长效中枢交感神经药物是主要的治疗方法，以最低剂量使用，以防止最大的高血压激增。由于反跳性高血压，应避免使用短效可乐定，但可以添加以控制残留的高血压发作，通常由精神压力或劳累引发。如有必要，可以通过对策和短效升压剂来控制低血压发作。
更新日期：2019-12-01
中文翻译：
传入压力反射衰竭的血压管理
传入压力反射衰竭最常见的原因是颈部手术或放疗导致颈动脉窦神经受损。临床表现的特点是血压极度不稳定，伴有严重的高血压危象、低血压发作和体位性低血压，使其成为最难控制的高血压形式。指导治疗的循证数据很少。建议依赖于对潜在病理生理学、相关临床药理学和轶事经验的了解。治疗的目标应该是改善生活质量，而不是使血压正常化，而这是很难实现的。长效中枢交感神经药物是主要的治疗方法，以最低剂量使用，以防止最大的高血压激增。由于反跳性高血压，应避免使用短效可乐定，但可以添加以控制残留的高血压发作，通常由精神压力或劳累引发。如有必要，可以通过对策和短效升压剂来控制低血压发作。
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