Central Sympatholytic Drugs

Abstract

J Clin Hypertens (Greenwich). 2011;13:658–661. ©2011 Wiley Periodicals, Inc. Key Points Central sympatholytic drugs reduce blood pressure mainly by stimulating central α2‐adrenergic receptors in the brainstem centers, thereby reducing sympathetic nerve activity and neuronal release of norepinephrine to the heart and peripheral circulation. This class of drugs, however, is currently used mainly as fourth‐line (or beyond) drug therapy for hypertension because of side effects of drowsiness, fatigue, and dry mouth. Rebound hypertension is also another major concern in certain drugs with a short half‐life, particularly in patients who are nonadherent to the regimen. Therefore, their use on a “PRN” basis for treatment of blood pressure surge in the absence of symptoms or acute target complications should also be avoided.

Carotid baroreflex activation therapy for resistant hypertension

“…In most patients, resistant hypertension can be controlled by using four or five antihypertensive agents, in addition to clonidine or other central sympatholytics drugs, but these are notori ous for causing somnolence, dry mouth, and rebound hypertension between doses (especially with pro re nata [PRN] dosing). 45,46 Whether carotid sinus pacemaker would be more appropriate for this cohort of patients still remains to be determined; this strategy could reduce, but not eliminate, medication requirements. The rationale for carotid baroreflex activation therapy in resistant hypertension is twofold.…”

Capítulo 7 – Tratamento Medicamentoso

“…Alpha-agonists of central action stimulate alpha-2 receptors involved in sympatho-inhibitory mechanisms. 40 Not all alpha-agonists of central action are selective. Their well-defined effects are as follows: a decrease in sympathetic activity and reflex of baroreceptors, contributing to relative bradycardia and postural hypotension; mild decrease in PVR and cardiac output; a reduction in serum levels of renin; and fluid retention.…”

“… 41 Clonidine has a higher risk for the rebound effect with discontinuation, especially when associated with a BB, and can be dangerous in the preoperative period. 40 The drugs in this class have adverse reactions due to their central action, such as drowsiness, sedation, dry mouth, fatigue, postural hypotension, and erectile dysfunction. 40 , 41 …”

“… 40 The drugs in this class have adverse reactions due to their central action, such as drowsiness, sedation, dry mouth, fatigue, postural hypotension, and erectile dysfunction. 40 , 41 …”

Expanding the Targets of Renal Sympathetic Denervation: From Resistant Hypertension to Atrial Fibrillation

“…Indeed, surgical attempts to disrupt this hyperactivity have been started in the early decades of the twentieth century [12]. Later on, several pharmacological substances were developed targeting the central or the peripheral divisions of the sympathetic nervous system (ganglionic blockers, a-methyl dopa, clonidine) [13,14]. Most of them are still in use.…”