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December 7, 1970

Autonomic Hyperreflexia

Author Affiliations

Rochester, Minn
Lexington, Ken

JAMA. 1970;214(10):1886. doi:10.1001/jama.1970.03180100076020

To the Editor.—  Neider et al stated in their article "Autonomic Hyperreflexia in Urologic Surgery" (213: 867, 1970) that sympatholytic agents have been ineffective for the treatment of autonomic hyperreflexia. We have previously presented1 two patients who responded to such agents, namely the α-adrenergic blocking agents phentolamine (Regitine) or phenoxybenzamine hydrochloride (Dibenzyline) or both. We proposed and demonstrated that doses larger than 5 mg of phentolamine might be needed to control the hypertensive paroxysms of autonomic hyperreflexia. In Nieder's patient the blood pressure decrease from 235/ 130 mm Hg to 190/110 mm Hg could have represented direct vasodilatation,2 but it is also possible that a repeated or larger dose of phentolamine may have controlled the hypertension.We agree with the authors that in most cases the more permanent methods of management are unnecessary. We suggest that the use of α-adrenergic blocking agents will also reduce the need for