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That blood pressure is highly variable over 24-hour, yet would be tightly controlled by the baroreflex system is a baroreflex paradox. Not only blood pressure varies but baroreflex sensitivity varies with it. Changes in baroreflex sensitivity can cause great changes in blood pressure, as we have shown in model studies. Consequently, the baromodulation hypothesis says that sensitivity modulation is the primary mechanism in the baroreflex that changes arterial pressure. The baroreflex then becomes not just a pressure stabilizer but a pressure controller: in interaction with other inputs such as coming from higher brain centers, it moves the blood pressure from one desired level to another. This system is effective, fast, and safe. We prefer not to use the word resetting for this mechanism but to reserve ‘resetting’ traditionally for changes in the receptor function. For resetting the baroreflex as a functional unit the word ‘baromodulation’ could be used. From recently recorded 24-hour 1/f blood pressure spectra it has again been confirmed that speaking of a baroreflex setpoint, even of a setpoint that is reset occasionally, is less appropriate. Blood pressure changes continuously and intentionally. Baromodulation is capable of doing that.
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