Bradbury–eggleston Syndrome in a Hypertensive Patient: A Therapeutic Challenge

Abstract

Background: Pure autonomic failure, historically known as Bradbury–Eggleston syndrome, is a neurodegenerative disorder of the autonomic nervous system characterized by orthostatic hypotension. When associated with supine hypertension, its management becomes particularly challenging due to the need to balance symptomatic relief with blood pressure control. Case Summary: We report the case of a 69-year-old woman with a history of arterial hypertension who presented with exertional dizziness. She exhibited supine systolic hypertension at rest, along with orthostatic hypotension without a compensatory tachycardic response, suggestive of autonomic dysfunction. Neurological examination was normal. Cardiovascular autonomic testing revealed beta-sympathetic impairment associated with neurogenic orthostatic hypotension. Secondary causes of dysautonomia were excluded, leading to the diagnosis of pure autonomic failure. Although the management of coexisting hypertension and orthostatic hypotension is challenging, a significant improvement in the patient’s functional status and blood pressure control was achieved through a personalized therapeutic approach. Discussion: The aim of this case report is to emphasize the importance of assessing autonomic function and blood pressure variations in hypertensive patients presenting with orthostatic symptoms, in order to implement appropriate and individualized therapeutic strategies patients.