Sympathetic Nervous System and Hypertension

DiBona, Gerald F.

doi:10.1161/hypertensionaha.111.00633

Cited by 187 publications

(119 citation statements)

References 31 publications

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“…This suggests that the sympathoinhibition may play a role in the favorable cardiovascular and metabolic effects of this therapeutic procedure reported in previous studies [5][6][7]10 and largely confirmed in the present one. This is not unexpected because the importance of sympathetic hyperactivity in the pathogenesis of hypertension is well documented [32][33][34] and so is, both in experimental animals and in man, its stimulating influence on leptin and insulin secretion, [35][36][37] as well as its ability to cause or worsen insulin resistance. 18,19 In the case of leptin, however, prevailing evidence suggests that the opposite is also true, namely that leptin may trigger central and peripheral sympathoexcitation.…”

Section: Discussionmentioning

confidence: 93%

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Seravalle

Colombo

et al. 2014

Hypertension

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L ong-term prospective studies have recently shown that bariatric surgery significantly reduces the risk of death in severely obese patients.1 This has been confirmed by retrospective analyses of a large cohort of obese individuals in whom surgery-related reductions in body weight were associated with a significant reduction in death rate compared with obese individuals followed under dietary and medical treatment. [2][3][4] It is a widespread belief that the protective effect of bariatric surgery in obese patients may perhaps be related to a reduction of body weight per se but that the concomitant improvement of the array of risk factors commonly associated with obesity, for example, alterations in lipid and glucose metabolism, is likely to play a major role. [5][6][7] In this context, however, little attention has to date been given to whether bariatric surgery is also associated with the improvement of another adverse phenomenon of obesity (ie, sympathetic activation). 8,9 The only information available comes from 3 studies that assessed sympathetic tone by making use of spectral analysis of heart rate signal or 24-hour norepinephrine urinary excretion [10][11][12] (ie, approaches that display major intrinsic limitations not allowing to provide any direct insight on the effects of the intervention on central sympathetic outflow, as the microneurographic technique only allows to achieve 13 .) The issue has pathophysiological and clinical relevance because sympathetic activation has been shown to be an adverse prognostic factor in several clinical conditions.14-17 Furthermore, evidence has been obtained that sympathetic overdrive may cause or worsen insulin resistance, 18,19 thus contributing to a common metabolic alteration in obesity.Abstract-Weight loss improves insulin sensitivity and exerts sympathomodulatory effects. No data, however, are available on the effects of the weight loss induced by vertical sleeve gastrectomy on sympathetic neural drive, insulin sensitivity, and their reciprocal cross talks. In 10 severe obese hypertensives (age, 54.0±2.3 years [mean±SEM]), we measured sphygmomanometric blood pressure, heart rate, body mass index, homeostatic model assessment index, plasma leptin, muscle sympathetic nerve traffic (microneurography), and baroreflex sensitivity (vasoactive drug technique). Measurements were performed 2 to 3 days before surgery and repeated 6 and 12 months after the procedure. Ten matched hypertensive obeses not undergoing gastrectomy served as controls. Six months after bariatric surgery, a significant (P<0.05) reduction in body mass index (−9.1±1.4 kg/m 2 ), sphygmomanometric systolic blood pressure (−10.2±4.5 mm Hg), heart rate (−11.0±2.4 bpm), homeostatic model assessment index (−3-3±1.3 AU), plasma leptin (−53.6±8.8 μg/L), and muscle sympathetic nerve traffic (−15.0±3.4 bursts/100 heart beats) was observed. The weight loss, the plasma leptin reduction, and the sympathetic inhibition were maintained after 12 months, whereas homeostatic model assessment index showed a tendency ...

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Section: Discussionmentioning

confidence: 93%

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Seravalle

Colombo

et al. 2014

Hypertension

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“…1,2 Fibrosis is estimated to contribute to 45% of all causes of mortality 3 and is promoted by many factors present in damaged kidneys and CKD, including oxidative stress, inflammation, hypertension, hypoxia, metabolic toxins, and activation of the sympathetic nervous system (SNS). [4][5][6][7][8][9][10][11][12] The association of hypertensive renal disease with dietary salt is well recognized. [13][14][15][16] Many patients with CKD have salt-sensitive hypertension.…”

mentioning

confidence: 99%

A Salt-Induced Reno-Cerebral Reflex Activates Renin-Angiotensin Systems and Promotes CKD Progression

Cao

Wang

et al. 2015

Journal of the American Society of Nephrology

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Salt intake promotes progression of CKD by uncertain mechanisms. We hypothesized that a salt-induced reno-cerebral reflex activates a renin-angiotensin axis to promote CKD. Sham-operated and 5/6-nephrectomized rats received a normal-salt (0.4%), low-salt (0.02%), or high-salt (4%) diet for 2 weeks. High salt in 5/6-nephrectomized rats increased renal NADPH oxidase, inflammation, BP, and albuminuria. Furthermore, high salt activated the intrarenal and cerebral, but not the systemic, renin-angiotensin axes and increased the activity of renal sympathetic nerves and neurons in the forebrain of these rats. Renal fibrosis was increased 2.2-fold by high versus low salt, but intracerebroventricular tempol, losartan, or clonidine reduced this fibrosis by 65%, 69%, or 59%, respectively, and renal denervation or deafferentation reduced this fibrosis by 43% or 38%, respectively (all P,0.05). Salt-induced fibrosis persisted after normalization of BP with hydralazine. These data suggest that the renal and cerebral renin-angiotensin axes are interlinked by a reno-cerebral reflex that is activated by salt and promotes oxidative stress, fibrosis, and progression of CKD independent of BP.

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“…5,6 Moreover, ≈15% of all hypertensive patients have resistant hypertension, and fail to achieve blood pressure goals, despite 3 or more antihypertensive medications. [7][8][9] Because the renal sympathetic nervous system is considered to be essential for the development of arterial hypertension, 10,11 renal sympathetic denervation using catheter-based radiofrequency ablation is a promising new option for patients suffering resistant hypertension. However, the arterial wall injury induced by radiofrequency energy remains a concern, because radiofrequency has been shown to acutely induce luminal thrombus deposition and late stenosis of the renal artery (RA).…”

mentioning

confidence: 99%

Comparison of Renal Artery, Soft Tissue, and Nerve Damage After Irrigated Versus Nonirrigated Radiofrequency Ablation

Sakakura¹,

Ladich²,

Fuimaono³

et al. 2015

Circ: Cardiovascular Interventions

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Background-The long-term efficacy of radiofrequency ablation of renal autonomic nerves has been proven in nonrandomized studies. However, long-term safety of the renal artery (RA) is of concern. The aim of our study was to determine if cooling during radiofrequency ablation preserved the RA while allowing equivalent nerve damage. Methods and Results-A total of 9 swine (18 RAs) were included, and allocated to irrigated radiofrequency (n=6 RAs, temperature setting: 50°C), conventional radiofrequency (n=6 RAs, nonirrigated, temperature setting: 65°C), and high-temperature radiofrequency (n=6 RAs, nonirrigated, temperature setting: 90°C) groups. RAs were harvested at 10 days, serially sectioned from proximal to distal including perirenal tissues and examined after paraffin embedding, and staining with hematoxylin-eosin and Movat pentachrome. RAs and periarterial tissue including nerves were semiquantitatively assessed and scored. A total of 660 histological sections from 18 RAs were histologically examined by light microscopy. Arterial medial injury was significantly less in the irrigated radiofrequency group (depth of medial injury, circumferential involvement, and thinning) than that in the conventional radiofrequency group (P<0.001 for circumference; P=0.003 for thinning). Severe collagen damage such as denatured collagen was also significantly less in the irrigated compared with the conventional radiofrequency group (P<0.001). Nerve damage although not statistically different between the irrigated radiofrequency group and conventional radiofrequency group (P=0.36), there was a trend toward less nerve damage in the irrigated compared with conventional. Compared to conventional radiofrequency, circumferential medial damage in highest-temperature nonirrigated radiofrequency group was significantly greater (P<0.001). Conclusions-Saline irrigation significantly reduces arterial and periarterial tissue damage during radiofrequency ablation, and there is a trend toward less nerve damage. (Circ Cardiovasc Interv. 2015;8:e001720.

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Sympathetic Nervous System and Hypertension

Cited by 187 publications

References 31 publications

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

A Salt-Induced Reno-Cerebral Reflex Activates Renin-Angiotensin Systems and Promotes CKD Progression

Comparison of Renal Artery, Soft Tissue, and Nerve Damage After Irrigated Versus Nonirrigated Radiofrequency Ablation

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