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Grassi G, Drager LF. Sympathetic overactivity, hypertension and cardiovascular disease: state of the art. Curr Med Res Opin 2024; 40:5-13. [PMID: 38597067 DOI: 10.1080/03007995.2024.2305248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 04/11/2024]
Abstract
Cardiovascular disease (CVD) remains the most prevalent cause of premature death worldwide. It had been suspected for decades that increased activity of the sympathetic nervous system (SNS) might play a pathogenetic role in the development and progression of hypertension, heart failure (HF) and CVD. The use of microneurographic techniques to directly assess the SNS has allowed this field to advance considerably in recent years. We now have compelling evidence for a key role of sympathetic overactivity in the pathogenesis and progression of hypertension and associated hypertension-mediated organ damage (such as endothelial dysfunction, arterial stiffness and left ventricular hypertrophy), HF (with or without reduced left ventricular ejection fraction). Sympathetic overactivity also drives increased cardiovascular risk in the settings of obesity, metabolic syndrome, chronic kidney disease and obstructive sleep apnoea, among other conditions. Thus, sympathetic overactivity is an important factor that drives patients through the CVD continuum, from the early appearance of cardiovascular risk factors, to impairments of the structure and function of components of the heart and arteries, to established CVD, and ultimately to a life-threatening cardiovascular event. A deeper understanding of the role of sympathetic overactivity in the pathogenesis of CVD and HF will support the optimization of therapeutic interventions for these conditions.
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Affiliation(s)
- Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Luciano F Drager
- Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Lozano WM, Ortiz-Guzmán JE, Arias-Mutis O, Bizy A, Genovés P, Such-Miquel L, Alberola A, Chorro FJ, Zarzoso M, Calvo CJ. Modifications of long-term heart rate variability produced in an experimental model of diet-induced metabolic syndrome. Interface Focus 2023; 13:20230030. [PMID: 38106920 PMCID: PMC10722215 DOI: 10.1098/rsfs.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Metabolic syndrome (MetS) has been linked to a higher prevalence of cardiac arrhythmias, the most frequent being atrial fibrillation, but the mechanisms are not well understood. One possible underlying mechanism may be an abnormal modulation of autonomic nervous system activity, which can be quantified by analysing heart rate variability (HRV). Our aim was to investigate the modifications of long-term HRV in an experimental model of diet-induced MetS to identify the early changes in HRV and the link between autonomic dysregulation and MetS components. NZW rabbits were randomly assigned to control (n = 10) or MetS (n = 10) groups, fed 28 weeks with high-fat, high-sucrose diet. 24-hour recordings were used to analyse HRV at week 28 using time-domain, frequency-domain and nonlinear analyses. Time-domain analysis showed a decrease in RR interval and triangular index (Ti). In the frequency domain, we found a decrease in the low frequency band. Nonlinear analyses showed a decrease in DFA-α1 and DFA-α2 (detrended fluctuations analysis) and maximum multiscale entropy. The strongest association between HRV parameters and markers of MetS was found between Ti and mean arterial pressure, and Ti and left atrial diameter, which could point towards the initial changes induced by the autonomic imbalance in MetS.
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Affiliation(s)
- W. M. Lozano
- Department of Physiology, Universitat de València, Valencia, Comunitat Valenciana, Spain
- School of Physiotherapy, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - J. E. Ortiz-Guzmán
- Department of Physiology, Universitat de València, Valencia, Comunitat Valenciana, Spain
| | - O. Arias-Mutis
- Department of Biomedical Sciences, CEU Cardenal Herrera, Moncada, Valenciana, Spain
- Health Research Institute - Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - A. Bizy
- Department of Biomedical Sciences, CEU Cardenal Herrera, Moncada, Valenciana, Spain
| | - P. Genovés
- Department of Physiology, Universitat de València, Valencia, Comunitat Valenciana, Spain
| | - L. Such-Miquel
- Department of Physiotherapy, Universitat de València, València, Spain
| | - A. Alberola
- Department of Physiology, Universitat de València, Valencia, Comunitat Valenciana, Spain
| | - F. J. Chorro
- Health Research Institute - Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Department of Medicine, Universitat de València, València, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - M. Zarzoso
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- Department of Physiotherapy, Universitat de València, València, Spain
| | - C. J. Calvo
- Department of Physiology, Universitat de València, Valencia, Comunitat Valenciana, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- CSIC-UPV, Instrumentation for Molecular Imaging Technologies Research Institute (I3M), Universitat Politècnica de València, València, Spain
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Grassi G, Dell'Oro R, Bombelli M, Cuspidi C, Quarti-Trevano F. High blood pressure with elevated resting heart rate: a high risk "Sympathetic" clinical phenotype. Hypertens Res 2023; 46:2318-2325. [PMID: 37500715 DOI: 10.1038/s41440-023-01394-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023]
Abstract
Epidemiological studies have unequivocally shown that elevated heart rate values measured at rest have an adverse prognostic impact in the hypertensive patient, being associated with an increased risk of cardiovascular events and complications. In recent years new data have been collected on this issue, strengthening the clinical relevance of elevated heart rate as a specific hypertensive phenotype. The present paper will review old and new data on the prognostic importance of resting tachycardia in the hypertensive patient. It will also examine the role of the sympathetic nervous system in the development of this alteration as well as its therapeutic implications. The different approaches to dynamically assess heart rate values in the clinical setting will be finally discussed.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Ram M, Patel T, Khatri M. Response to "Heart rate threshold for cardiovascular risk and sympathetic activation in metabolic syndrome". Curr Probl Cardiol 2023; 48:101780. [PMID: 37172864 DOI: 10.1016/j.cpcardiol.2023.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Meva Ram
- Shaheed Mohtarma Benazir Bhutto Medical Collge Lyari, Karachi City, Sindh, Pakistan.
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Grassi G. Response to the Letter regarding article "Heart rate threshold for cardiovascular risk and sympathetic activation in metabolic syndrome". Acta Diabetol 2023; 60:1115-1116. [PMID: 37209166 DOI: 10.1007/s00592-023-02106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University Milano-Biocca, Via Pergolesi 33, 20052, Monza, Milan, Italy.
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