Role of the Sympathetic Nervous System in Hypertension and Hypertension-Related Cardiovascular Disease
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REVIEW ARTICLE
Role of the Sympathetic Nervous System in Hypertension and Hypertension-Related Cardiovascular Disease Gino Seravalle • Giuseppe Mancia Guido Grassi
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Received: 10 February 2014 / Accepted: 18 April 2014 Ó Springer International Publishing Switzerland 2014
Abstract A number of cardiovascular disease have been shown to be characterized by a marked increase in sympathetic drive to the heart and the peripheral circulation. This is the case for essential hypertension, congestive heart failure, cardiac arrhythmias, obesity, metabolic syndrome, obstructive sleep apnea, and chronic renal disease. This review focuses on the most recent findings documenting the role of sympathetic neural factors in the development and progression of the hypertensive state as well as in the pathogenesis of hypertension-related target organ damage. It also reviews the role of sympathetic neural factors in the development of cardiovascular diseases not necessarily strictly related to the hypertensive state, such as congestive heart failure, cardiac arrhythmias, obesity, metabolic syndrome and renal failure. The paper will finally review the pharmacological and non-pharmacological interventions acting on the sympathetic drive. Emphasis will be given to the new approaches, such as renal nerves ablation and carotid baroreceptor stimulation, which have been shown to exert sympathoinhibitory effects.
G. Seravalle (&) Cardiology Department, St. Luca Hospital, IRCCS Istituto Auxologico Italiano, Piazza Brescia 20, 20149 Milan, Italy e-mail: [email protected] G. Mancia G. Grassi Clinica Medica, Department of Clinical Medicine and Prevention, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy G. Mancia G. Grassi Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy G. Grassi IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
Keywords Sympathetic nervous system Cardiovascular disease Target organ damage Antiadrenergic therapy Hypertension Congestive heart failure Hypertension Obesity Metabolic syndrome Renal failure Renal denervation Carotid baroreceptor stimulation
1 Introduction The sympathetic nervous system has a fundamental role in maintaining the physiological homeostasis of the cardiovascular system. For this action the sympathetic nervous system is modulated by different mechanisms: (a) hormonal (renin–angiotensin–aldosterone system, cortisol, vasopressin, growth hormone, asymmetric dimethylarginine, endothelin, gonadic hormones); (b) metabolic (insulin, leptin, free fatty acids); (c) reflex (baroreceptors, cardiopulmonary receptors, chemoreceptors); (d) inflammatory (ROS system, cytokines) and (e) endothelial and hematologic. The sympathetic nervous system has a wide range of actions that are predominant at cardiovascular level, i.e. heart rate acceleration, increase in cardiac contractility, reduction of venous capacitance and constriction of resistance vessels [1]. Of course several other organs undergo the action of the sympathetic nervous system [1]. T
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