The deadly line linking sympathetic overdrive, dipping status and vascular risk: critical appraisal and therapeutic implications

Santilli, Francesca; Simeone, Paola; D’Ardes, Damiano; Davı̀, Giovanni

doi:10.1038/hr.2016.27

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…The phenomenon of sympathetic overdrive has received attention recently, with observations that the elevated sympathetic nervous activation can influence outcomes, particularly in younger, obese subjects or in smokers. 70,71 Moreover, different antihypertensive drug classes may reduce sympathetic activation (β-blockers, RAS blockers), have no effect (long-acting calcium channel blockers) or increase it (diuretics, short-acting calcium channel blockers). 70 The use of β-blockade has been shown to be at least as effective as other antihypertensive agents for improving outcomes in younger hypertensive subjects.…”

Section: Take-home Messages: β-Blockers In Ihd Managementmentioning

confidence: 99%

β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now?

Pathak¹,

Mrabeti²

2021

VHRM

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β-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for β 1 vs β 2 receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through β 2 stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of β-blockade in these conditions arises from blockade of the β 1 receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of β-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective β-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective β 1 -adrenoceptor blocker, bisoprolol.

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Section: Take-home Messages: β-Blockers In Ihd Managementmentioning

confidence: 99%

β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now?

Pathak¹,

Mrabeti²

2021

VHRM

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“…This physiological phenomenon is commonly indicated as "dipping" and appears to be protective for cardiovascular health [4]. Dipping is mostly due to endogenous circadian rhythms of the autonomic nervous and endocrine systems, as well as to exogenous patterns of activity during the 24 h [5,6]. Sometimes, the nocturnal blood pressure trend evidences some alterations, and people do not present BP dipping.…”

Section: Introductionmentioning

confidence: 99%

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

Casagrande

Favieri

Guarino

et al. 2020

IJERPH

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Introduction: The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. Methods: We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State-Trait Anger Expression Inventory was used to assess anger. Results: Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. Conclusions: These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon. different declinations of BP dipping may occur. In some individuals, an excessive reduction of BP (Extreme Dipping), or an increase of the BP trend after sleep onset (Reverse Dipping) may be reported. Earlier studies mainly focused on the absence of dipping, highlighting that a non-dipping pattern is a significant predictor of a range of organ damage and cardiovascular events [3,7,8]. The increase of cardiovascular risk associated with Non-Dipping seems to be due to the difficulty in physiological recovering from the typical demand-driven elevations of blood pressure during the waking hours of the day [9] and it is characterized by a disruption of the circadian rhythm of the autonomic balance [10]. Accordingly, some studies suggested that Non-Dippers have a high sympathetic nervous system activity during wake time [11][12][13] and a lower parasympathetic nervous system activity throughout the sleep period [13,14].However, the exact causes of Non-Dipping are not fully clarified [15][16][17], and genetic, biological, environmental, and sociodemogra...

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