Abstract: SA-PO299
Baroreceptor Failure – A Rare Form of Secondary Hypertension
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Chin, Kai, San Antonio Military Medical Center, San Antonio, Texas, United States
- Wickham, Jesse M., San Antonio Military Medical Center, San Antonio, Texas, United States
Introduction
Baroreceptors in the neck play a large role in blood pressure (BP) regulation. They sense distension of the vessel wall and help stabilize blood pressures during changes in volume and/or posture. Injury to the baroreceptors can cause extremely labile blood pressure with BP surges. We present a case of baroreceptor failure, a rare form of secondary hypertension.
Case Description
A 65-year-old male with hypertension (HTN), anxiety and soft palate cancer s/p radiation therapy was admitted for planned carotid endarterectomy. Patient’s BP rose to 290/102mmHg when he was placed supine in the operating room. Surgery was aborted and nephrology was consulted to assist with BP therapy and secondary workup. Patient stated these BP surges had been occurring for years. However, they only began after he received radiation therapy to his neck at age 55. His current medications were Felodipine 10mg daily and Carvedilol 12.5mg twice daily. Patient kept detailed BP logs 6 times a day with average BP 210s/100s mmHg, with surges to 260 mmHg systolic. Patient stated he used to be on many BP medications to treat his surges, but it would cause severe hypotension if he didn't have surges. Patient had a secondary HTN workup which was negative for pheochromocytoma, hyperaldosteronism, and renal artery stenosis. He also had Positron Emission Tomography and Computerized Tomography scans done for surveillance of his cancer, which were negative for new masses. As a result, we concluded the patient likely had baroreceptor failure caused by radiation therapy to his neck. Review of the literature showed that Clonidine and benzodiazepines are beneficial in limiting BP surges. He was started on Clonidine 0.1mg/24hr patch and discharged with follow-up to titrate his Clonidine and wean his other BP medications. His Alprazolam for anxiety was switched to Diazepam as well. After 3 months, patient was on Clonidine 0.4mg/24hr patch, Valium 10mg BID and no longer on Felodipine or Carvedilol. His peak surge BPs are now 180 mmHg systolic, and average BP is now 160-180/70-90 mmHg.
Discussion
Baroreceptor failure is a rare form of secondary hypertension, but it can be suspected if a patient presents with very labile blood pressure and high BP surges. Very commonly, there is a history of neck trauma (i.e. radiation therapy, neck surgery). Clonidine (central alpha-2 agonists) and benzodiazepines are effective in reducing blood pressure surges.