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In a recent issue of the ARCHIVES, Dr Mann provided evidence for a psychiatric origin of some cases of paroxysmal hypertension.¹ Herein, I describe a woman whose symptoms of paroxysmal despair were likely related to extreme blood pressure fluctuation in the setting of idiopathic dysautonomia.

Report of a Case

A 68-year-old woman with a progressive syndrome of dysautonomia of unknown etiology despite extensive medical and neurologic evaluation presented to a depression research clinic with a 6-year history of depressive symptoms. Her dysautonomia was manifested by symptomatic labile hypertension and daily postprandial hypotension. Her peak blood pressure recorded in our clinic was 222/113 mm Hg accompanied by flushing. Her documented symptomatic low blood pressure was 50/40 mm Hg. She also had asthma and gastroesophageal reflux, both likely related to dysautonomia. She underwent a lumpectomy and radiation therapy in 1983 for cancer of the breast. Her medications were hydralizine hydrochloride, cisapride (Propulsid), omeprazole, and fexofenadine hydrochloride.

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