BLOOD PRESSURE INSTABILITY FROM RADIATION THERAPY FOR HEAD AND NECK CANCER

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This covers baroreflex receptor and other problems related to radiation. this is an answer and information from Dr. Itzhak Brook MD.

This is a question posed to Dr. Brook and his answer to it.

The Question:

Dr. Brook, thank you for sharing your article. I survived Stage IV throat cancer that started in my tonsil in 2014. I received 36 radiation treatments and chemotherapy. The treatments eventually resulted in radiation fibrosis in my neck and face.

After a few years my baroreflex receptor also became fibrotic and no longer functions. As a result my blood pressure wildly fluctuates. I can go from 200+/100+ to 60/40 within a couple hours. After being passed between doctors for years, and adversely reacting to a number of HBP medications, they finally settled on 5mg Lisinopril and 5mg Alprazolam at night. This doesn't seem to do much, as I suffer from LBP quite often and extreme HBP when I visit the doctor.

I'd appreciate your sharing any links etc as there is not a lot of information on this condition available, that I can find any way. Thank you.

Dr. Brook's Answer:

Hypertension and hypotension due to baroreceptors damage: Radiation to the head and neck can damage the baroreceptors located in the carotid artery. These baroreceptors help in regulating blood pressure by detecting the pressure of blood flowing through them, and sending messages to the central nervous system to increase or decrease the peripheral vascular resistance and cardiac output. Some individual treated with radiation develop low, labile or paroxysmal hypertension.

Low blood pressure: This can be cause by damage to the peripheral and autonomic nervous system and the carotid baroreceptors. This can lead to baroreceptor failure expressed as orthostatic hypotension (intolerance) which is characterized by dizziness when standing up from a sitting or lying down. This can be managed by standing up slowly, wearing of compression stockings, exercising and by keeping well hydrated.

Labile hypertension: In this condition the blood pressure fluctuates far more than usual within the day. It can rapidly soar from low (e.g., 120/80 mm Hg) to high (e.g., 170/105 mm Hg). In many instances these fluctuations are asymptomatic but may be associated with headaches. A relationship between blood pressure elevation and stress or emotional distress is usually present.

Paroxysmal hypertension: Patients exhibit sudden elevation of blood pressure (which can be greater than 200/110 mm Hg) associated with an abrupt onset of distressful physical symptoms, such as headache, chest pain, dizziness, nausea, palpitations, flushing, and sweating. Episodes can last from 10 minutes to several hours and may occur once every few months to once or twice daily. Between episodes, the blood pressure is normal or may be mildly elevated. Patients generally cannot identify obvious psychological factors that cause the paroxysms. Medical conditions that can also cause such blood pressure swings need to be excluded (e.g., pheochromocytoma).

Both of these conditions are serious and should be treated. Management can be difficult and should be done by experienced specialists. If there is stenosis of the carotid artery, correcting it can improve the baroreceptor failure.

Dr Samuel Mann from Weill-Cornell Medical Center in New York City is one of the leading experts in treating paroxysmal hypertension. https://weillcornell.org/smann . The Vanderbilt Autonomic Dysfunction Center is one of the nation's leading expert centers in dysautonomia, or autonomic dysfunction. https://www.vumc.org/autonomic-dysfunction-center/vanderbilt-autonomic-dysfunction

Itzhak Brook MD

Take Care, May God Bless & Watch Over You

Russ