Case ReportSevere impaired blood pressure control caused by baroreflex failure as a late sequela of neck irradiationPiani, Federicaa; Landolfo, Matteoa; Fiorini, Giuliaa; D’Addato, Sergioa; Mancia, Giuseppeb; Borghi, ClaudioaAuthor Information aDepartment of Surgical and Medical Sciences, University of Bologna, Bologna bDepartment of Internal Medicine, University of Milano-Bicocca, Milan, Italy Correspondence to Giulia Fiorini, PhD, Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy. E-mail: firstname.lastname@example.org Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; HR, heart rate; nOH, neurogenic orthostatic hypotension; nSH, neurogenic supine hypertension Received 6 June, 2019 Revised 10 September, 2019 Accepted 24 September, 2019 Journal of Hypertension: March 2020 - Volume 38 - Issue 3 - p 553-556 doi: 10.1097/HJH.0000000000002286 Buy Metrics Abstract A 64-year-old man, whose medical history was significant only for locally advanced squamocellular carcinoma of the right palatine tonsil treated with extended neck radiotherapy 9 years before, was evaluated for traumatic cerebral haemorrhage secondary to syncope after a postural change. The selective angiographic study of cerebral vessels was negative. No heart arrhythmias were recorded at ECG monitoring. The 24-h ABPM revealed sudden pressor and depressor episodes during day-time and a reverse dipper pattern during night-time. Noninvasive autonomic nervous system function testing showed supine hypertension and orthostatic hypotension caused by afferent baroreflex failure. According to literature, even if only few cases are described, neck irradiation can be assumed to be the major cause of baroreflex failure. No treatment is currently approved. The patient was treated with a selective beta-blocker (bisoprolol) administered at bedtime. Repeated ABPM after 1 month of therapy showed absence of sudden pressor and depressor episodes and no dipper pattern during night-time. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.