Diagnostik und Therapie des Baroreflexversagens

Zusammenfassung

Der gesunde Baroreflex verhindert exzessive Fluktuationen des Blutdrucks. Eine beidseitige Schädigung von Barorezeptoren der großen Gefäße oder der Baroreflexafferenzen kann Baroreflexversagen verursachen. Häufigtse Ursache sind ausgedehnte chirurgische Eingriffe und Strahlentherapie im Halsbereich. Das führende klinische Symptom bei Baroreflexversagen ist eine zum Teil schwere arterielle Hypertonie mit stark schwankenden Blutdruckwerten. Blutdruckanstiege werden häufig durch psychische oder körperliche Belastung oder auch durch Schmerzreize getriggert. Einige Patienten leiden typischerweise in Ruhe unter episodenhaft auftretender Hypotonie und Bradykardie. Die Patienten benötigen eine Kombinationstherapie, die einerseits die Hypertonie vermindert und andererseits Hypotonie und Bradykardien vermindert.

Abstract

Healthy baroreflexes prevent excessive blood pressure swings. Bilateral damage to baro­receptors in large arteries or baroreflex afferents can cause baroreflex failure. The leading causes are extensive surgery and radiation of the neck. The prominent clinical feature of baroreflex fail­ure is often severe arterial hypertension with ­large blood pressure swings. Hypertensive episodes can be triggered by psychological stress, physical exercise, and pain. A minority of baroreflex failure patients presents with episodes of hypotension and bradycardia. Some patients also experience hypotensive and bradycardic episodes that typically occur rest. Patients may require a combination of treatments that diminish hypertensive episodes, attenuate hypotension, and prevent bradycardia.

Schlüsselwörter

Baroreflexversagen - sympathisches Nervensystem - vegetatives Nervensystem - Hypertonie - Hypotonie

Key words

baroreflex failure - sympathetic nervous system - autonomic - hypertension - hypotension

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