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.
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.
Boylan LS. Mutual Influences Between Paroxysmal Hypertension and Psychiatric Disturbance. Arch Intern Med. 1999;159(17):2091-2092. doi: