Pathophysiology of Resistant Hypertension: The Role of Sympathetic Nervous System

Abstract

Resistant hypertension (RH) is a powerful risk factor for cardiovascular morbidity and mortality. Among the characteristics of patients with RH, obesity, obstructive sleep apnea, and aldosterone excess are covering a great area of the mosaic of RH phenotype. Increased sympathetic nervous system (SNS) activity is present in all these underlying conditions, supporting its crucial role in the pathophysiology of antihypertensive treatment resistance. Current clinical and experimental knowledge points towards an impact of several factors on SNS activation, namely, insulin resistance, adipokines, endothelial dysfunction, cyclic intermittent hypoxaemia, aldosterone effects on central nervous system, chemoreceptors, and baroreceptors dysregulation. The further investigation and understanding of the mechanisms leading to SNS activation could reveal novel therapeutic targets and expand our treatment options in the challenging management of RH.

Endovascular radiofrequency renal denervation in resistant hypertension: a single center experience

“…[7][8][9] Stimulation of renal sympathetic nerves leads to increased secretion of renin, increased tubular sodium reabsorption, and reduced renal blood flow. 10 Notably, resistant hypertension has been shown to be characterized by a marked increase of sympathetic activity.…”

“…In particular, increased sympathetic activity has been shown to characterize resistant hypertension. [7][8][9][10] Historically, radical surgical methods for sympathetic denervation have been successful in lowering blood pressure in severely hypertensive patients. However, these methods of sympathectomy were associated with high perioperative morbidity and serious long-term complications.…”

Renal Denervation for Resistant Hypertension

“…Although some studies have suggested that the nerve fibers are relatively deep, 4 Atherton examined post mortem specimens and reported that 50% of renal nerves are located within 1 mm of the lumen and 90% less than 2 mm deep. 5 Investigators performed autopsies on 25 humans, identifying ten thousand nerves along the renal arteries.…”

Leptina e aldosterona na atividade simpática na hipertensão resistente, com ou sem Diabetes Tipo 2

“…In addition, aldosterone promotes RHTN by mediating maladaptive changes in the renal, cardiovascular and central nervous systems 8 . Sympathetic nervous system (SNS) activation seems to be a basic component of the adverse impact of aldosterone excess in the central nervous system 9 .…”

“…Considering the significant influences that leptin and aldosterone exerts on the pathophysiology of RHTN 9,13 , we aimed to access the relationship between sympathetic activity and these two hormones in RHTN with and without type 2 diabetes (T2D).…”