Autonomic Testing Profile in Adults with Afferent Baroreflex Failure

The baroreflex failure syndrome refers to the cardiovascular manifestations resulting from interruption of the afferent limb of the baroreflex at the level of the carotid sinus, baroreceptor afferents, or medulla. The main manifestations are acute hypertension or fluctuating hypertension; other manifestations include orthostatic hypotension, orthostatic tachycardia, or episodes of severe bradycardia and hypotension. The main causes of baroreflex failure are bilateral carotid sinus surgery and radiation of the neck. The diagnosis of baroreflex failure is based on the clinical history, demonstration of fluctuating hypertension, autonomic testing showing impaired baroreceptor control of heart rate, and exclusion of systemic causes such as pheochromocytoma. Management includes patient education, avoidance of vasoactive drugs, clonidine or diazepam for management of hypertension, and salt intake and fludrocortisone to prevent hypotension.