Baroreflex Failure -- A Diagnostic Challenge

In this issue of the Journal, Robertson et al.1 admirably characterize a poorly understood and rarely recognized syndrome, baroreflex failure. The hallmark of this syndrome is marked lability of blood pressure, with systolic and diastolic hypertension and tachycardia (usually lasting 3 to 30 minutes, but sometimes persisting for several days) alternating at times with hypotension and relative bradycardia24. Some patients may have sustained hypertension with periods of lability. The rarity of baroreflex failure is evidenced by its identification in only 11 of 500 patients referred to the Autonomic Dysfunction Center at Vanderbilt University for autonomic or blood-pressure problems . . .