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I. Functional and Neurogenic Causes

Irwin J. Schatz, MD

Arch Intern Med. 1984;144(4):773-777.

Abstract
• The maintenance of adequate upright BP requires both a baroreceptor-mediated feedback loop and an effective circulating blood volume. Although functional disruptions of these mechanisms are reversible and common, several permanent and often progressive neurologic disorders exist that interfere with necessary reflexes and orthostatic BP control. Multiple system atrophy affects diffuse neurologic systems; autonomic dysfunction causes a failure of peripheral vasoconstriction from defective sympathetic stimulation. Idiopathic orthostatic hypotension is a selective disorder of autonomic nerves; postganglionic neurons cannot release norepinephrine properly and are supersensitive to exogenous pressors. Conversely, excessive sympathetic discharge occurs in sympathicotonic orthostatic hypotension, the pathogenesis and incidence of which are unclear. Any peripheral neuropathy may Interfere with sympathetic vasoconstrictor activity and Is most commonly seen in diabetes mellitus.

(Arch Intern Med 1984;144:773-777)

Author Affiliations
From the Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu.

Footnotes
Accepted for publication Dec 15, 1983.

Reprint requests to the Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana St, Honolulu, HI 96813 (Dr Schatz).

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