Exercise‐Induced Hypertension: a Rare Manifestation of Pure Autonomic Failure

Sakakibara R, Ogawa E, Kishi M, Uchiyama T, Yamamoto T. Exercise‐Induced Hypertension: a Rare Manifestation of Pure Autonomic Failure.  European Neurological Journal, June 2010; 2(1):  99-101

Case report


Ryuji Sakakibara ¹, Emina Ogawa ¹, Masahiko Kishi ¹, Tomoyuki Uchiyama 2 and Tatsuya Yamamoto ²

Affiliations: ¹Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan and ²Department of Neurology, Chiba University, Chiba, Japan


ABSTRACT

Pure autonomic failure (PAF) is an idiopathic neurodegenerative disorder that presents with clinical symptoms of autonomic dysfunction, but no other neurological deficits. The main structure affected in PAF is the pre‐ and postganglionic sympathetic autonomic neurons, where Lewy body pathology has been documented. Cardinal features of PAF are cardiovascular, urinary, gastrointestinal, and other forms of autonomic nervous system involvement. Among these, cardiovascular dysfunction occurs earlier than bladder dysfunction and becomes a predominant clinical manifestation in PAF, which contrasts with the early genitourinary dysfunction in multiple system atrophy patients. Progression of PAF is usually slow and insidious; therefore, it can be treated conservatively. Whereas postural, postprandial, exercise, and micturition‐induced hypotension are all cardinal features in such patients, recumbent and exercise‐induced hypertension may also occur. Although the exact mechanism of exercise‐induced hypertension remains obscure, the balance of adrenergic receptors, particularly altered alpha1 vasoconstrictor function, might contribute to exercise‐induced hypertension. Recognition of exercise‐induced hypertension is important in order to avoid potential life‐threatening adverse events.

Keywords: pure autonomic failure, exercise, hypertension
Correspondence: Ryuji Sakakibara, Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564‐1 Shimoshizu, Sakura, 285‐8741, Japan. Tel: (81)‐43‐462‐8811, Ext. 2323; Fax: (81)‐43‐487‐4246; e‐mail: sakakibara@sakura.med.toho‐u.ac.jp