Baroreflex failure may have a number of clinical features.


Core findings:

(1) presence of one or more risk factors (see previous section)

(2) excessive excursion in the heart rate during normal daily activities, with stress increasing and sedation decreasing the heart rate

(3) failure of bradycardia to occur after administration of phenylephrine or other pressor

(4) failure of tachycardia to occur after the administration of nitroprusside


Four "faces" of baroreflex failure (Ketch et al):

(1) hypertensive crisis with severe, unremitting hypertension, headache and tachycardia

(2) volatile hypertension

(3) orthostatic tachycardia

(4) malignant vagotonia (severe bradycardia and asystole due to increase vagal parasympathetic tone)


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