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Biffi A, Quarti-Trevano F, Vanoli J, Dell'Oro R, Corrao G, Mancia G, Grassi G. Effects of acute carotid baroreceptor stimulation on sympathetic nerve traffic in resistant and uncontrolled hypertension: a systematic review and meta-analysis. Hypertens Res 2024; 47:1962-1969. [PMID: 38760523 DOI: 10.1038/s41440-024-01704-9] [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: 01/05/2024] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 05/19/2024]
Abstract
In resistant hypertensive patients acute carotid baroreflex stimulation is associated with a blood pressure (BP) reduction, believed to be mediated by a central sympathoinhbition.The evidence for this sympathomodulatory effect is limited, however. This meta-analysis is the first to examine the sympathomodulatory effects of acute carotid baroreflex stimulation in drug-resistant and uncontrolled hypertension, based on the results of microneurographic studies. The analysis included 3 studies assessing muscle sympathetic nerve activity (MSNA) and examining 41 resistant uncontrolled hypertensives. The evaluation included assessment of the relationships between MSNA and clinic heart rate and BP changes associated with the procedure. Carotid baroreflex stimulation induced an acute reduction in clinic systolic and diastolic BP which achieved statistical significance for the former variable only [systolic BP: -19.98 mmHg (90% CI, -30.52, -9.43), P < 0.002], [diastolic BP: -5.49 mmHg (90% CI, -11.38, 0.39), P = NS]. These BP changes were accompanied by a significant MSNA reduction [-4.28 bursts/min (90% CI, -8.62, 0.06), P < 0.07], and by a significant heart rate decrease [-3.65 beats/min (90% CI, -5.49, -1.81), P < 0.001]. No significant relationship was detected beween the MSNA, systolic and diastolic BP changes induced by the procedure, this being the case also for heart rate. Our data show that the acute BP lowering responses to carotid baroreflex stimulation, although associated with a significant MSNA reduction, are not quantitatively related to the sympathomoderating effects of the procedure. This may suggest that these BP effects depend only in part on central sympathoinhibition, at least in the acute phase following the intervention.
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Affiliation(s)
- Annalisa Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University Milano-Bicocca, Milano, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy
| | - Jennifer Vanoli
- Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University Milano-Bicocca, Milano, Italy
| | - Giuseppe Mancia
- Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy.
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Milošević M, Otašević P. Treatment-resistant hypertension. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-34248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Treatment-resistant hypertension is one of the most significant causes of poor blood pressure regulation. Patients with resistant hypertension are at a higher risk of developing comorbidities compared to the general hypertensive population. As a result, these patients have an increased incidence of disability and premature death, as well as increased treatment costs. Due to the above-mentioned, in the last decade, there has been an increase in researchers' interest in elucidating the pathogenesis, diagnosis, and treatment of resistant hypertension. However, recent data indicate that 20% of female and 24% of male patients with arterial hypertension still have uncontrolled blood pressure, despite maximum doses of three antihypertensive drugs (including a diuretic) and appropriate lifestyle measures. New treatment modalities (i.e. devicebased interventions - catheter-based renal denervation and baroreceptor stimulation) offer hope for achieving adequate blood pressure regulation in these patients. In this paper, we have summarized previous knowledge about the mechanisms underlying the pathogenesis of resistant hypertension, as well as optimal diagnostic methods to differentiate true from pseudo-resistant hypertension. We have also given an overview of the current therapeutic approach, including optimal medical therapy and new treatment modalities (i.e. device-based interventions) and their role in the treatment of resistant hypertension.
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Kuzmin OB, Buchneva NN, Zhezha VV, Serdyuk SV. Uncontrolled Arterial Hypertension: Kidney, Neurohormonal Imbalance, and Approaches to Antihypertensive Drug Therapy. ACTA ACUST UNITED AC 2019; 59:64-71. [DOI: 10.18087/cardio.2019.12.n547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/29/2019] [Indexed: 11/18/2022]
Abstract
Resistant and refractory arterial hypertensions are two distinct clinical phenotypes of uncontrolled arterial hypertension (AH), which differ in their sensitivity to antihypertensive drug therapy. The review presents data obtained in clinical studies devoted to elucidating the involvement of disorders of neurohormonal status and renal function in the formation of resistant and refractory arterial hypertension, to and the development of new approaches to increasing the effectiveness of antihypertensive therapy in these patient’s populations. The results of these studies have shown that in patients with uncontrolled arterial hypertension, despite prolonged intake ≥ 3 antihypertensive drugs with different mechanisms of action, including a diuretic, excess sodium reabsorption persists in the distal segments of nephron due to increased aldosterone activity and sympathetic nervous system hyperactivity. In this regard, special attention has been paid to the data of PATHWAY-2, PATHWAY-3 and ReHOT trials that in patients with resistant AH tested the clinical efficacy of spironolactone, amiloride, and antiadrenergic drugs bisoprolol, doxazosin and clonidine, suppressing activity of the sympathetic nervous system.
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Fricke L, Petroff D, Desch S, Lurz P, Reinhardt S, Sonnabend M, Classen J, Baum P. Does dysfunction of the autonomic nervous system affect success of renal denervation in reducing blood pressure? SAGE Open Med 2017; 5:2050312117702031. [PMID: 28507735 PMCID: PMC5415324 DOI: 10.1177/2050312117702031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/06/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives: Renal denervation is an interventional approach aiming to reduce high blood pressure. Its efficacy is subject of controversial debate. We analyzed autonomic function in patients undergoing renal denervation to identify responders. Methods: A total of 21 patients with treatment-resistant hypertension scheduled for renal denervation were included. Heart rate variability, pupillary function and sympathetic skin response were examined prior to intervention. Before and 1 or 3 months after intervention, 24-h ambulatory blood pressure readings were taken. Results: Patients were stratified according to sympathetic nervous system function. Sympathetic activity was reduced in 12 participants (group 1) and normal or enhanced in nine patients (group 2). The mean of daytime systolic blood pressure decreased in groups 1 and 2 from 168 to 157 mmHg (95% confidence interval for difference, 1–21 mmHg, p = 0.035) and from 166 to 145 mmHg (8–34 mmHg, p = 0.005), respectively. In a linear model, blood pressure reduction was 11.3 mmHg (0.3–22 mmHg) greater in group 2 than in group 1 (p = 0.045). Conclusion: Patients with preexisting reduced activity of the sympathetic nervous system benefited less from renal denervation.
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Affiliation(s)
- Lisa Fricke
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, Leipzig University, Leipzig, Germany
| | - Steffen Desch
- Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Lübeck Heart Centre, University of Lübeck, Lübeck, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Centre, Leipzig University, Leipzig, Germany
| | - Sebastian Reinhardt
- Department of Cardiology and Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Melanie Sonnabend
- Department of Internal Medicine/Cardiology, Heart Centre, Leipzig University, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Petra Baum
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
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Taddei S, Dal Canto E, Bruno RM. Renal denervation for resistant hypertension: no. Intern Emerg Med 2016; 11:495-8. [PMID: 27001888 DOI: 10.1007/s11739-016-1428-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/25/2016] [Indexed: 11/25/2022]
Abstract
In recent years, catheter-based radiofrequency denervation of the renal arteries (RDN) has emerged as a potential treatment for resistant hypertension. Though initial non-randomized and randomized small studies demonstrate large reductions in office blood pressure, RDN superiority to conventional treatment is not confirmed either by randomized controlled trials or by large international registries. Increasing evidence supports the hypothesis that a rational pharmacological therapeutic scheme is equally or more effective; this approach, together with an intervention aimed at increasing patient's compliance with treatment, might solve most of the cases of refractory hypertension. Thus, based on current evidence, renal denervation should not be routinely used to treat resistant hypertension. Though the possibility that RDN might be useful in other subsets of hypertensive patients exists, it has never been proven. Thus, its use should be limited to extreme situations, when all other possible treatments have failed.
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Affiliation(s)
- Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Elisa Dal Canto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
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Santilli F, Simeone P, D'Ardes D, Davì G. The deadly line linking sympathetic overdrive, dipping status and vascular risk: critical appraisal and therapeutic implications. Hypertens Res 2016; 39:404-6. [PMID: 26984299 DOI: 10.1038/hr.2016.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Francesca Santilli
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
| | - Paola Simeone
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
| | - Damiano D'Ardes
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
| | - Giovanni Davì
- Center of Excellence on Aging, 'G. d'Annunzio' University Foundation and Department of Medicine and Aging, University of Chieti 'G. d'Annunzio' School of Medicine, Chieti, Italy
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Does sympathetic overactivation feature all hypertensives? Differences of sympathovagal balance according to night/day blood pressure ratio in patients with essential hypertension. Hypertens Res 2016; 39:440-8. [PMID: 26865002 DOI: 10.1038/hr.2016.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/14/2015] [Accepted: 12/14/2015] [Indexed: 12/20/2022]
Abstract
When evaluating the 'night/day BP ratio', both hypertensives and normotensives can be arbitrarily classified into four groups: extreme dippers (ratio ⩽0.8), dippers (0.8<ratio ⩽0.9), mild dippers (0.9<ratio⩽1.0) and reverse dippers (ratio ⩾1.0). Reverse and mild dipper hypertensives have poorer prognoses compared with the physiological dipper profile, but the prognostic relevance of the extreme dipper profile remains uncertain. The evaluation of heart rate variability (HRV), obtained by 24-h Holter ECG monitoring, is the most frequently used noninvasive form of assessment of the activity of the autonomic nervous system. Reverse and mild dipper hypertensives have reduced HRV, indicating an overactivation of the sympathetic nervous system (SNS); however, the HRV behavior in extreme dippers is still controversial. The goal of this study was to compare HRV indexes of extreme vs. reverse dipper essential hypertensives measured on the basis of time domains. We enrolled 125 hypertensive subjects, divided in 4 quartiles according to day/night blood pressure (BP) ratios. The upper and lower quartiles (31 subjects per quartile) were compared; 30 normotensive subjects were enrolled as a control group. Time domain HRV parameters of the three groups revealed a higher degree of sympathetic activation in the lower quartile (reverse dipper) vs. the upper quartile (extreme) and normotensive controls. HRV parameters related to parasympathetic tone did not show any significant variations among the three groups. Contrary to common belief, not all hypertensives have SNS overactivation.
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Effect of selective vagal nerve stimulation on blood pressure, heart rate and respiratory rate in rats under metoprolol medication. Hypertens Res 2015; 39:79-87. [DOI: 10.1038/hr.2015.122] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/06/2015] [Accepted: 09/13/2015] [Indexed: 11/08/2022]
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Taddei S, Bruno RM. Renal denervation: back to reality, finally! EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:57. [PMID: 27533967 DOI: 10.1093/ehjcvp/pvu013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
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