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Zoccali C, Ortiz A, Blumbyte IA, Rudolf S, Beck-Sickinger AG, Malyszko J, Spasovski G, Carriazo S, Viggiano D, Kurganaite J, Sarkeviciene V, Rastenyte D, Figurek A, Rroji M, Mayer C, Arici M, Martino G, Tedeschi G, Bruchfeld A, Spoto B, Rychlik I, Wiecek A, Okusa M, Remuzzi G, Mallamaci F. Neuropeptide Y as a risk factor for cardiorenal disease and cognitive dysfunction in CKD: translational opportunities and challenges. Nephrol Dial Transplant 2021; 37:ii14-ii23. [PMID: 34724060 PMCID: PMC8713155 DOI: 10.1093/ndt/gfab284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Neuropeptide Y (NPY) is a 36-amino-acid peptide member of a family also including peptide YY and pancreatic polypeptide, which are all ligands to Gi/Go coupled receptors. NPY regulates several fundamental biologic functions including appetite/satiety, sex and reproduction, learning and memory, cardiovascular and renal function and immune functions. The mesenteric circulation is a major source of NPY in the blood in man and this peptide is considered a key regulator of gut–brain cross talk. A progressive increase in circulating NPY accompanies the progression of chronic kidney disease (CKD) toward kidney failure and NPY robustly predicts cardiovascular events in this population. Furthermore, NPY is suspected as a possible player in accelerated cognitive function decline and dementia in patients with CKD and in dialysis patients. In theory, interfering with the NPY system has relevant potential for the treatment of diverse diseases from cardiovascular and renal diseases to diseases of the central nervous system. Pharmaceutical formulations for effective drug delivery and cost, as well as the complexity of diseases potentially addressable by NPY/NPY antagonists, have been a problem until now. This in part explains the slow progress of knowledge about the NPY system in the clinical arena. There is now renewed research interest in the NPY system in psychopharmacology and in pharmacology in general and new studies and a new breed of clinical trials may eventually bring the expected benefits in human health with drugs interfering with this system.
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Affiliation(s)
- Carmine Zoccali
- Renal Research Institute, New York,USA and Associazione Ipertensione Nefrologia Trapianto Renale (IPNET) Reggio Cal., Italy c/o CNR-IFC, Ospedali Riuniti, Reggio Calabria, Italy
| | - Alberto Ortiz
- Institute of Biochemistry, Leipzig University, Faculty of Life Sciences, Leipzig, Germany
| | - Inga Arune Blumbyte
- Lithuanian University of Health Sciences, Nephrology Department, Kaunas, Lithuania
| | - Sarina Rudolf
- Institute of Biochemistry, Leipzig University, Faculty of Life Sciences, Leipzig, Germany
| | | | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Goce Spasovski
- Department of Nephrology, University "Sts. Cyril and Methodius", Skopje, MK, Republic of Macedonia
| | - Sol Carriazo
- Institute of Biochemistry, Leipzig University, Faculty of Life Sciences, Leipzig, Germany
| | - Davide Viggiano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. and Biogem Scarl, Ariano Irpino, Italy
| | - Justina Kurganaite
- Lithuanian University of Health Sciences, Nephrology Department, Kaunas, Lithuania
| | - Vaiva Sarkeviciene
- Lithuanian University of Health Sciences, Nephrology Department, Kaunas, Lithuania
| | - Daiva Rastenyte
- Lithuanian University of Health Sciences, Neurology Department, Kaunas, Lithuania
| | - Andreja Figurek
- Department of Nephrology, University "Sts. Cyril and Methodius", Skopje, MK, Republic of Macedonia
| | - Merita Rroji
- Department of Nephrology, University "Sts. Cyril and Methodius", Skopje, MK, Republic of Macedonia
| | - Christopher Mayer
- Health and Bioresources, Biomedical Systems, Austrian Institute of Technology, Vienna, Austria
| | - Mustapha Arici
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gianvito Martino
- Neurology Department, San Raffaele Scientific Institute and Vita-Salute University San Raffaele, Milan, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, and 3T-MRI Research Center, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden and Department of Renal Medicine, CLINTEC Karolinska Institutet, Stockholm, Sweden
| | | | - Ivan Rychlik
- Department of Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady,Prague, Czech Republic
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Mark Okusa
- Division of Nephrology and Center for Immunity, Inflammation, and Regenerative Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Bergamo, Italy
| | - Francesca Mallamaci
- Nephrology and Transplantation Unit, Grande Ospedale Metropolitano and CNR-IFC, Reggio Cal, Italy
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Sympathetic nerve traffic overactivity in chronic kidney disease: a systematic review and meta-analysis. J Hypertens 2020; 39:408-416. [PMID: 33031182 DOI: 10.1097/hjh.0000000000002661] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies based on microneurographic sympathetic nerve activity (MSNA) recordings have shown that the sympathetic system is overactivated in chronic kidney disease (CKD) patients but the relationship between MSNA and renal function and other risk factors has not been systematically reviewed in this population. DESIGN AND MEASUREMENTS This meta-analysis compares MSNA in cardiovascular complications-free CKD patients (n = 638) and healthy individuals (n = 372) and assesses the relationship of MSNA with the eGFR, age, BMI and hemodynamic variables. RESULTS In a global analysis, MSNA was higher in CKD patients than in healthy control individuals (P < 0.001). The difference in MSNA between patients and healthy individuals was more marked in end-stage kidney diseases patients than in stage 3A 3B CKD patients (P < 0.001). In an analysis combining patients and healthy individuals, MSNA rose gradually across progressively lower eGFR categories (P < 0.01). In separate meta-regression analyses in CKD patients and in healthy individuals, MSNA associated directly with age (CKD: r = 0.57, P = 0.022; healthy individuals: r = 0.71, P = 0.031) and with the BMI (r = 0.75, P = 0.001 and r = 0.93, P = 0.003). In both groups, MSNA correlated with heart rate (r = 0.77, P = 0.02 and r = 0.66, P = 0.01) but was unrelated to plasma norepinephrine. CONCLUSION Independently of comorbidities, MSNA is markedly increased in CKD patients as compared with healthy individuals and it is related to renal function, age, the BMI and heart rate. Sympathetic activation intensifies as CKD progresses toward kidney failure and such an intensification is paralleled by a progressive rise in heart rate but it is not reflected by plasma norepinephrine.
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Zoccali C, D'Arrigo G, Leonardis D, Pizzini P, Postorino M, Tripepi G, Mallamaci F, van den Brand J, van Zuilen A, Wetzels J, Bots ML, Blankestijn P. Neuropeptide Y and chronic kidney disease progression: a cohort study. Nephrol Dial Transplant 2019; 33:1805-1812. [PMID: 29370406 DOI: 10.1093/ndt/gfx351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022] Open
Abstract
Background Neuropeptide Y (NPY) is a sympathetic neurotransmitter that has been implicated in various disorders including obesity, gastrointestinal and cardiovascular diseases. Methods We investigated the relationship between circulating NPY and the progression of the glomerular filtration rate (GFR) and proteinuria and the risk for a combined renal endpoint (>30% GFR loss, dialysis/transplantation) in two European chronic kidney disease (CKD) cohorts including follow-up of 753 and 576 patients for 36 and 57 months, respectively. Results Average plasma NPY was 104 ± 32 pmol/L in the first CKD cohort and 119 ± 41 pmol/L in the second one. In separate analyses of the two cohorts, NPY associated with the progression of the estimated GFR (eGFR) and proteinuria over time in both unadjusted and adjusted {eGFR: -3.60 mL/min/1.73 m2 [95% confidence interval (CI): -4.46 to - 2.74] P < 0.001 and -0.83 mL/min/1.73 m2 (-1.41 to - 0.25, P = 0.005); proteinuria: 0.18 g/24 h (0.11-0.25) P < 0.001 and 0.07 g/24 h (0.005-0.14) P = 0.033} analyses by the mixed linear model. Accordingly, in a combined analysis of the two cohorts accounting for the competitive risk of death (Fine and Gray model), NPY predicted (P = 0.005) the renal endpoint [sub-distribution hazard ratio (SHR): 1.09; 95% CI: 1.03-1.16; P = 0.005] and the SHR in the first cohort (1.14, 95% CI: 1.04-1.25) did not differ (P = 0.25) from that in the second cohort (1.06, 95% CI: 0.98-1.15). Conclusions NPY associates with proteinuria and faster CKD progression as well as with a higher risk of kidney failure. These findings suggest that the sympathetic system and/or properties intrinsic to the NPY molecule may play a role in CKD progression.
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Affiliation(s)
- Carmine Zoccali
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Graziella D'Arrigo
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Daniela Leonardis
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Patrizia Pizzini
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Maurizio Postorino
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giovanni Tripepi
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Francesca Mallamaci
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Jan van den Brand
- Radboud University Nijmegen Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - Arjan van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jack Wetzels
- Radboud University Nijmegen Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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Lu P, Jiang SJ, Pan H, Xu AL, Wang GH, Ma CL, Shi Z. Short hairpin RNA interference targeting interleukin 1 receptor type I in the paraventricular nucleus attenuates hypertension in rats. Pflugers Arch 2017; 470:439-448. [PMID: 29143938 DOI: 10.1007/s00424-017-2081-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 01/08/2023]
Abstract
Blood pressure is controlled by tonic sympathetic activities, excessive activation of which contributes to the pathogenesis and progression of hypertension. Interleukin (IL)-1β in the paraventricular nucleus (PVN) is involved in sympathetic overdrive and hypertension. Here, we investigated the therapeutic effects of IL-1 receptor type I (IL-1R1) gene silencing in the PVN on hypertension. Recombinant lentivirus vectors expressing a short hairpin RNA (shRNA) targeting IL-1R1 (Lv-shR-IL-1R1) or a control shRNA were microinjected into PVN of spontaneously hypertensive rats (SHRs) and normotensive WKY rats. The fluorescence of green fluorescent protein-labelled vectors appeared at 2 weeks after injection and persisted for at least 8 weeks. IL-1R1 protein expression in the PVN was reduced 4 weeks after Lv-shR-IL-1R1 injection in SHRs. IL-1R1 interference also reduced basal sympathetic activity, cardiac sympathetic afferent reflex in SHRs. Depressor effects were observed from week 2 to 10 after Lv-shR-IL-1R1 treatment in SHRs, with the most prominent effects seen at the end of week 4. Furthermore, Lv-shR-IL-1R1 treatment decreased the ratio of left ventricular weight to body weight and cross-sectional areas of myocardial cells in SHRs. Additionally, Lv-shR-IL-1R1 treatment prevented an increase in superoxide anion and pro-inflammatory cytokines (PICs, TNF-α and IL-1β) in the PVN of SHR, and upregulated anti-inflammatory cytokine (AIC, IL-10) expression. These results indicate that shRNA interference targeting IL-1R1 in the PVN decreases arterial blood pressure, attenuates excessive sympathetic activity and cardiac sympathetic afferent reflex, and improves myocardial remodelling in SHRs by restoring the balance between PICs and AICs to attenuate oxidative stress.
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Affiliation(s)
- Peng Lu
- Department of Education, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264003, China.,Shandong Province Key Laboratory of Stroke, Yantai, 264003, China
| | - Shu-Jun Jiang
- Department of Physiology, Binzhou Medical University, 346 Guanhai Rd, Laishan District, Yantai, Shandong Province, 264003, China
| | - Hong Pan
- Department of Physiology, Binzhou Medical University, 346 Guanhai Rd, Laishan District, Yantai, Shandong Province, 264003, China
| | - Ai-Li Xu
- Department of Physiology, Binzhou Medical University, 346 Guanhai Rd, Laishan District, Yantai, Shandong Province, 264003, China
| | - Gui-Hua Wang
- Experimental Teaching Management Center, Binzhou Medical University, Yantai, 264003, China
| | - Chun-Lei Ma
- Department of Physiology, Binzhou Medical University, 346 Guanhai Rd, Laishan District, Yantai, Shandong Province, 264003, China.,Shandong Province Key Laboratory of Stroke, Yantai, 264003, China
| | - Zhen Shi
- Department of Physiology, Binzhou Medical University, 346 Guanhai Rd, Laishan District, Yantai, Shandong Province, 264003, China.
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Renal sympathetic stimulation and ablation affect ventricular arrhythmia by modulating autonomic activity in a cesium-induced long QT canine model. Heart Rhythm 2017; 14:912-919. [DOI: 10.1016/j.hrthm.2017.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 11/17/2022]
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Angiotensin-(1–7) enhances the effects of angiotensin II on the cardiac sympathetic afferent reflex and sympathetic activity in rostral ventrolateral medulla in renovascular hypertensive rats. ACTA ACUST UNITED AC 2015; 9:865-77. [DOI: 10.1016/j.jash.2015.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/11/2015] [Accepted: 08/06/2015] [Indexed: 11/21/2022]
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LI PENG, GONG JUEXIAO, SUN WEI, ZHOU BIN, KONG XIANGQING. Hexamethonium attenuates sympathetic activity and blood pressure in spontaneously hypertensive rats. Mol Med Rep 2015; 12:7116-22. [DOI: 10.3892/mmr.2015.4315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 07/29/2015] [Indexed: 11/05/2022] Open
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Blanch GT, Freiria-Oliveira AH, Speretta GFF, Carrera EJ, Li H, Speth RC, Colombari E, Sumners C, Colombari DSA. Increased expression of angiotensin II type 2 receptors in the solitary-vagal complex blunts renovascular hypertension. Hypertension 2014; 64:777-83. [PMID: 24958505 DOI: 10.1161/hypertensionaha.114.03188] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Angiotensin II increases and decreases arterial pressure by acting at angiotensin type 1 and type 2 receptors, respectively. Renovascular hypertensive rats exhibit a high level of activity of the peripheral and central renin-angiotensin system. Therefore, in the present study, we evaluated the effect of increasing the expression of angiotensin type 2 receptors in the solitary-vagal complex (nucleus of the solitary tract/dorsal motor nucleus of the vagus), a key brain stem region for cardiovascular regulation, on the development of renovascular hypertension. Holtzman normotensive rats were implanted with a silver clip around the left renal artery to induce 2-kidney 1-clip renovascular hypertension. Three weeks later, rats were microinjected in the solitary-vagal complex with either an adenoassociated virus to increase the expression of angiotensin type 2 receptors or with a control vector. We observed that increasing angiotensin type 2 receptor expression in the solitary-vagal complex attenuated the development of renovascular hypertension and also reversed the impairment of the baroreflex and the increase in the low-frequency component of systolic blood pressure observed in renovascular hypertensive rats. Furthermore, an observed decrease in mRNA levels of angiotensin-converting enzyme 2 in the solitary-vagal complex of renovascular hypertensive rats was restored to control levels after viral-mediated increases in angiotensin type 2 receptors at this site. Collectively, these data demonstrate specific and beneficial effects of angiotensin type 2 receptors via the brain of hypertensive rats and suggest that central angiotensin type 2 receptors may be a potential target for therapeutics in renovascular hypertension.
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Affiliation(s)
- Graziela Torres Blanch
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.)
| | - André Henrique Freiria-Oliveira
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.)
| | - Guilherme Fleury Fina Speretta
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.)
| | - Eduardo J Carrera
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.)
| | - Hongwei Li
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.)
| | - Robert C Speth
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.)
| | - Eduardo Colombari
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.)
| | - Colin Sumners
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.).
| | - Débora S A Colombari
- From the Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil (G.T.B., A.H.F.-O., G.F.F.S., E.C., D.S.A.C.); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL (E.J.C., R.C.S.); School of Biotechnology, Southern Medical University, Guangzhou, China (H.L.); and Department of Physiology and Functional Genomics and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville (C.S., R.C.S.).
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Revealing the role of the autonomic nervous system in the development and maintenance of Goldblatt hypertension in rats. Auton Neurosci 2014; 183:23-9. [PMID: 24560525 PMCID: PMC4079011 DOI: 10.1016/j.autneu.2014.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/27/2014] [Accepted: 02/01/2014] [Indexed: 11/30/2022]
Abstract
Despite extensive use of the renovascular/Goldblatt model of hypertension—2K-1C, and the use of renal denervation to treat drug resistant hypertensive patients, autonomic mechanisms that underpin the maintenance of this hypertension are important yet remain unclear. Our aim was to analyse cardiovascular autonomic function by power spectral density analysis of both arterial pressure and pulse interval measured continuously by radio telemetry for 6 weeks after renal artery clipping. Mean arterial pressure increased from 106 ± 5 to 185 ± 2 mm Hg during 5 weeks post clipping when it stabilized. A tachycardia developed during the 4th week, which plateaued between weeks 5 and 6. The gain of the cardiac vagal baroreflex decreased immediately after clipping and continued to do so until the 5th week when it plateaued (from − 2.4 ± 0.09 to − 0.8 ± 0.04 bpm/mm Hg; P < 0.05). A similar time course of changes in the high frequency power spectral density of the pulse interval was observed (decrease from 13.4 ± 0.6 to 8.3 ± 0.01 ms2; P < 0.05). There was an increase in both the very low frequency and low frequency components of systolic blood pressure that occurred 3 and 4 weeks after clipping, respectively. Thus, we show for the first time the temporal profile of autonomic mechanisms underpinning the initiation, development and maintenance of renovascular hypertension including: an immediate depression of cardiac baroreflex gain followed by a delayed cardiac sympathetic predominance; elevated sympathetic vasomotor drive occurring after the initiation of the hypertension but coinciding during its mid-development and maintenance.
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Li P, Sun HJ, Cui BP, Zhou YB, Han Y. Angiotensin-(1-7) in the rostral ventrolateral medulla modulates enhanced cardiac sympathetic afferent reflex and sympathetic activation in renovascular hypertensive rats. Hypertension 2013; 61:820-7. [PMID: 23424239 DOI: 10.1161/hypertensionaha.111.00191] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Enhancement of the cardiac sympathetic afferent reflex (CSAR) contributes to sympathetic excitation in hypertension. The aim of the present study was to determine whether angiotensin (Ang)-(1-7) in the rostral ventrolateral medulla (RVLM) modulated the enhanced CSAR and sympathetic activation, and the signaling pathways that mediated these effects in the 2-kidney, 1-clip renovascular hypertension model. Cardiac sympathetic afferent reflex was evaluated using renal sympathetic nerve activity and mean arterial pressure responses to epicardial capsaicin application in anesthetized sinoaortic-denervated and cervical-vagotomized rats. RVLM microinjection of Ang-(1-7) induced greater increases in renal sympathetic nerve activity and mean arterial pressure, and greater enhancement in CSAR in 2-kidney, 1-clip rats than in sham-operated rats, which was blocked by Mas receptor antagonist A-779, adenylyl cyclase inhibitors SQ22536 and MDL-12,330A, and protein kinase A inhibitors rp-adenosine-3',5'-cyclic monophosphorothionate and H-89. Mas receptor expression in RVLM was increased in 2-kidney, 1-clip rats. Treatment with A-779, SQ22536, MDL-12,330A, rp-adenosine-3',5'-cyclic monophosphorothionate, or H-89 in RVLM inhibited CSAR and decreased renal sympathetic nerve activity and mean arterial pressure in 2-kidney, 1-clip rats, whereas cAMP analogue dibutyryl-cAMP had the opposite effects. Ang-(1-7) in RVLM increased, whereas A-779 decreased the cAMP level and the epicardial capsaicin application-induced increases in the cAMP level in RVLM. These results indicate that Ang-(1-7) in the RVLM enhances the CSAR and increases the sympathetic outflow and blood pressure via Mas receptor activation. The increased endogenous Ang-(1-7) and Mas receptor activity in RVLM contributes to the enhanced CSAR and sympathetic activation in renovascular hypertension, and the cAMP-protein kinase A pathway is involved in these Ang-(1-7)-mediated effects in the RVLM.
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Affiliation(s)
- Peng Li
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
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Sun HJ, Li P, Chen WW, Xiong XQ, Han Y. Angiotensin II and angiotensin-(1-7) in paraventricular nucleus modulate cardiac sympathetic afferent reflex in renovascular hypertensive rats. PLoS One 2012; 7:e52557. [PMID: 23285085 PMCID: PMC3527547 DOI: 10.1371/journal.pone.0052557] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 11/15/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The enhanced cardiac sympathetic afferent reflex (CSAR) is involved in the sympathetic activation that contributes to the pathogenesis and progression of hypertension. Activation of AT(1) receptors by angiotension (Ang) II in the paraventricular nucleus (PVN) augments the enhanced CSAR and sympathetic outflow in hypertension. The present study is designed to determine whether Ang-(1-7) in PVN plays the similar roles as Ang II and the interaction between Ang-(1-7) and Ang II on CSAR in renovascular hypertension. METHODOLOGY/PRINCIPAL FINDINGS The two-kidney, one-clip (2K1C) method was used to induce renovascular hypertension. The CSAR was evaluated by the renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) responses to epicardial application of capsaicin in sinoaortic-denervated and cervical-vagotomized rats with urethane and α-chloralose anesthesia. Either Ang II or Ang-(1-7) in PVN caused greater increases in RSNA and MAP, and enhancement in CSAR in 2K1C rats than in sham-operated (Sham) rats. Mas receptor antagonist A-779 and AT(1) receptor antagonist losartan induced opposite effects to Ang-(1-7) or Ang II respectively in 2K1C rats, but losartan had no effects in Sham rats. Losartan but not the A-779 abolished the effects of Ang II, while A-779 but not the losartan blocked the effects of Ang-(1-7). PVN pretreatment with Ang-(1-7) dose-dependently augmented the RSNA, MAP, and CSAR responses to the Ang II in 2K1C rats. Ang II level, AT(1) receptor and Mas receptor protein expression in PVN increased in 2K1C rats compared with Sham rats but Ang-(1-7) level did not. CONCLUSIONS Ang-(1-7) in PVN is as effective as Ang II in enhancing the CSAR and increasing sympathetic outflow and both endogenous Ang-(1-7) and Ang II in PVN contribute to the enhanced CSAR and sympathetic outflow in renovascular hypertension. Ang-(1-7) in PVN potentiates the effects of Ang II in renovascular hypertension.
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Affiliation(s)
- Hai-Jian Sun
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peng Li
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei-Wei Chen
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao-Qing Xiong
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Han
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
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12
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Han Y, Fan ZD, Yuan N, Xie GQ, Gao J, De W, Gao XY, Zhu GQ. Superoxide anions in the paraventricular nucleus mediate the enhanced cardiac sympathetic afferent reflex and sympathetic activity in renovascular hypertensive rats. J Appl Physiol (1985) 2011; 110:646-52. [DOI: 10.1152/japplphysiol.00908.2010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
An enhanced cardiac sympathetic afferent reflex (CSAR) is involved in the sympathetic activation in renovascular hypertension. The present study was designed to determine the role of superoxide anions in the paraventricular nucleus (PVN) in mediating the enhanced CSAR and sympathetic activity in renovascular hypertension in the two-kidney, one-clip (2K1C) model. Sinoaortic denervation and vagotomy were carried out, and renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) were recorded under anesthesia. The CSAR was evaluated by the response of RSNA to the epicardial application of capsaicin. Superoxide anion levels and NAD(P)H oxidase activity in the PVN increased in 2K1C rats and were much higher in 2K1C rats than in sham-operated (sham) rats after the epicardial application of capsaicin or PVN microinjection of ANG II. In both 2K1C and sham rats, PVN microinjection of the superoxide anion scavenger tempol or the NAD(P)H oxidase inhibitor apocynin abolished the CSAR, whereas the SOD inhibitor diethyldithiocarbamic acid (DETC) potentiated the CSAR. Tempol and apocynin decreased but DETC increased baseline RSNA and MAP. ANG II in the PVN caused larger responses of the CSAR, baseline RSNA, and baseline MAP in 2K1C rats than in sham rats. The effects of ANG II were abolished by pretreatment with tempol or apocynin in both 2K1C and sham rats and augmented by DETC in the PVN in 2K1C rats. These results indicate that superoxide anions in the PVN mediate the CSAR and the effects of ANG II in the PVN. Increased superoxide anions in the PVN contribute to the enhanced CSAR and sympathetic activity in renovascular hypertension.
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Affiliation(s)
- Ying Han
- Departments of 1Physiology and
- Biochemical and Molecular Biology, Nanjing Medical University, Nanjing, China
| | | | | | | | | | - Wei De
- Biochemical and Molecular Biology, Nanjing Medical University, Nanjing, China
| | | | - Guo-Qing Zhu
- Departments of 1Physiology and
- Biochemical and Molecular Biology, Nanjing Medical University, Nanjing, China
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Zhu GQ, Xu Y, Zhou LM, Li YH, Fan LM, Wang W, Gao XY, Chen Q. Enhanced cardiac sympathetic afferent reflex involved in sympathetic overactivity in renovascular hypertensive rats. Exp Physiol 2009; 94:785-94. [DOI: 10.1113/expphysiol.2008.046565] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Weck M. Treatment of hypertension in patients with diabetes mellitus. Clin Res Cardiol 2007; 96:707-18. [PMID: 17593318 DOI: 10.1007/s00392-007-0535-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 04/11/2007] [Indexed: 10/23/2022]
Abstract
Antihypertensive treatment in diabetes mellitus, especially in diabetics known to have cardiac autonomic neuropathy, may have to consider the status of the autonomic nervous system. In diabetic subjects with cardiac autonomic neuropathy, vagal activity during the night is often reduced. The reduction results in relative or absolute sympathetic activation, which could increase cardiovascular risk. Pathophysiological and clinical data suggests that antihypertensive treatment should reduce rather than induce sympathetic activity in this setting. Beta blocking agents, ACE inhibitors, calcium antagonists of verapamil or diltiazem type and selective imidazoline receptor agonists reduce sympathetic activity and, therefore, may have a beneficial effect in diabetic patients with disturbed sympathovagal balance.
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Affiliation(s)
- Matthias Weck
- Clinic Bavaria Kreischa, Department of Diabetes, Metabolism and Endocrinology, An der Wolfsschlucht 1-2, 01731 Kreischa, Germany.
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15
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Bialostozky D, Leyva M, Villarreal T, Casanova JM, Pérez-Grovas H, Lemus P, Jiménez G, Vallejo E, Jiménez-Angeles L, Herrera J, Altamirano J. Myocardial Perfusion and Ventricular Function Assessed by SPECT and Gated-SPECT in End-Stage Renal Disease Patients before and after Renal Transplant. Arch Med Res 2007; 38:227-33. [PMID: 17227733 DOI: 10.1016/j.arcmed.2006.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Accepted: 09/25/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiovascular disease is a major cause of morbidity and mortality in end-stage renal disease (ESRD). Renal transplant is known to improve left ventricle hypertrophy and systolic dysfunction in selected groups of patients. METHODS We assessed myocardial perfusion, wall motion and functional parameters by single photon emission computed tomography (SPECT) and Gated-SPECT in 30 consecutive ESRD patients with normal coronary angiograms before and after renal transplantation. RESULTS Uremic cardiomyopathy improved significantly after the transplant. The proportion of patients with angina decreased from 26 to 0%; the frequency of cardiomegaly decreased from 57 to 20% (p <0.01); the frequency of segments with perfusion defects decreased from 42.7 to 10.2% (p <0.001); the proportion of patients with low left ventricular ejection fraction (LVEF) dropped from 53.3 to 20% (p <0.001); and mean LVEF increased from (48.0 +/- 9.7% to 58.2 +/- 8.2%). Similarly, the proportion of segments showing systolic wall thickening, hypokinesia and dyskinesia also decreased significantly after renal transplant (p <0.01). CONCLUSIONS Uremic cardiomyopathy may be potentially reversible in patients with normal angiographic coronary arteries after renal transplant in a relatively short period of time. SPECT and Gated-SPECT are objective gateway methods to determine myocardial perfusion, hypokinesia, dyskinesia, and functional parameters (left ventricular ejection fraction and systolic wall thickening) and may be useful to establish diagnostic, coronariographic, prognostic, and therapeutic indications.
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Affiliation(s)
- David Bialostozky
- Servicio de Cardiología Nuclear, Instituto Nacional de Cardiología Ignacio Chavez, México, DF, México
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Abstract
Hypertension is common in chronic renal disease and is a risk factor for the faster progression of renal damage, and reduction of blood pressure (BP) is an efficient way of preventing or slowing the progression of this damage. International guidelines recommend lowering BP to 140/90 mm Hg or less in patients with uncomplicated hypertension, and to 130/80 mm Hg or less for patients with diabetic or chronic renal disease. The attainment of these goals needs to be aggressively pursued with multidrug antihypertensive regimens, if needed. The pathogenesis of hypertensive renal damage involves mediators from various extracellular systems, including the renin-angiotensin system (RAS). Proteinuria, which occurs as a consequence of elevated intraglomerular pressure, is also directly nephrotoxic. As well as protecting the kidneys by reducing BP, antihypertensive drugs can also have direct effects on intrarenal mechanisms of damage, such as increased glomerular pressure and proteinuria. Antihypertensive drugs that have direct effects on intrarenal mechanisms may, therefore, have nephroprotective effects additional to those resulting from reductions in arterial BP. Whereas BP-lowering effects are common to all antihypertensive drugs, intrarenal effects differ between classes and between individual drugs within certain classes. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) have beneficial effects on proteinuria and declining renal function that appear to be mediated by factors additional to their effects on BP. These RAS inhibitors are recommended as a first-line antihypertensive approach in patients with chronic kidney disease. The addition of diuretics and calcium channel antagonists to RAS inhibitor therapy is also considered to be a rational strategy to reduce BP and preserve renal function. Calcium channel antagonists are a highly heterogeneous class of compounds, and it appears that some agents are more suitable for use in patients with chronic renal disease than others. Manidipine is a third-generation dihydropyridine (DHP) calcium channel antagonist that blocks both L and T-type calcium channels. Unlike older-generation DHPs, which preferentially act on L-type channels, manidipine has been shown to have beneficial effects on intrarenal haemodynamics, proteinuria and other measures of renal functional decline in the first clinical trials involving hypertensive patients with chronic renal failure. Preliminary results from a trial in diabetic patients who had uncontrolled hypertension and microalbuminuria despite optimal therapy with an ACE inhibitor or an ARB suggest that manidipine may be an excellent antihypertensive drug in combination with RAS inhibitor treatment in order to normalise BP and albumin excretion in patients with diabetes.
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Affiliation(s)
- René R Wenzel
- Clinic of Internal Medicine, Cardiology, Nephrology and Hypertension, General Hospital Zell am See, Zell am See, Austria.
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Izzo JL. Hypertension in the metabolic syndrome and diabetes: pathogenesis, clinical studies, and treatment. J Clin Hypertens (Greenwich) 2003; 5:3-10. [PMID: 14688488 PMCID: PMC8099212 DOI: 10.1111/j.1524-6175.2003.02670.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increasing prevalence of obesity, hypertension, and abnormal glucose metabolism is a major challenge to health care in industrialized societies. This brief review summarizes the mechanistic evidence and clinical studies related to the problem of hypertension in the metabolic syndrome and diabetes to allow clinicians to provide more effective and enlightened management of these common, interrelated problems.
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Affiliation(s)
- Joseph L Izzo
- Department of Medicine, State University of New York at Buffalo, Buffalo, NY 14209, USA.
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Cice G, Ferrara L, D'Andrea A, D'Isa S, Di Benedetto A, Cittadini A, Russo PE, Golino P, Calabrò R. Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. J Am Coll Cardiol 2003; 41:1438-44. [PMID: 12742278 DOI: 10.1016/s0735-1097(03)00241-9] [Citation(s) in RCA: 357] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We sought to evaluate the effects of carvedilol on mortality and morbidity in dialysis patients with dilated cardiomyopathy. BACKGROUND Several lines of evidence support the concept that therapy with beta-blocking agents reduces morbidity and mortality in patients with congestive heart failure (HF), but the demonstration of such a survival benefit in dialysis patients with dilated cardiomyopathy is still lacking. METHODS A total of 114 dialysis patients with dilated cardiomyopathy were randomized to receive either carvedilol or placebo in addition to standard therapy. A first analysis was performed at one year and was followed by an additional follow-up period of 12 months. RESULTS Two-year echocardiographic data revealed a significant attenuation of pathologic remodeling, with smaller cavity diameters and higher ejection fractions in the active treatment group than in the placebo group. At two years, 51.7% of the patients died in the carvedilol group, compared with 73.2% in the placebo group (p < 0.01). Furthermore, there were significantly fewer cardiovascular deaths (29.3%) and hospital admissions (34.5%) among patients receiving carvedilol than among those receiving a placebo (67.9% and 58.9%, respectively; p < 0.00001). The exploratory analyses revealed that fatal myocardial infarctions, fatal strokes, and hospital admissions for worsening HF were lower in the carvedilol group than in the placebo group. A reduction in sudden deaths and pump-failure deaths was also observed, though it did not reach statistical significance. CONCLUSIONS Carvedilol reduced morbidity and mortality in dialysis patients with dilated cardiomyopathy. These data suggest the use of carvedilol in all dialysis patients with chronic HF.
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Affiliation(s)
- Gennaro Cice
- Division of Cardiology, Second University of Naples, Naples, Italy.
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Benchetrit S, Green J, Katz D, Bernheim J, Rathaus M. Early endothelial dysfunction following renal mass reduction in rats. Eur J Clin Invest 2003; 33:26-33. [PMID: 12492449 DOI: 10.1046/j.1365-2362.2003.01102.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endothelial dysfunction has been previously described in severely hypertensive rats with renal mass reduction (RMR) receiving large dietary Na loads. Because hypertension and Na loading reduce endothelium-dependent vasodilation, the effect of renal failure per se is unclear. METHODS Responses to acetylcholine in noradrenaline-contracted isolated perfused mesenteric arteries were studied. Vessels were obtained from RMR rats kept on a normal diet, 3 and 10 days after surgery, and the results were compared with those from sham-operated rats (SN). The role of three putative mediators of endothelium-dependent vasodilation was assessed using: L-NAME (10(-4) mol L(-1)); indomethacin (INDO, 10(-5) mol L(-1)); and a mixture of charybdotoxin and apamin (C/A, both 10(-7) mol L(-1)), inhibitors of Ca-activated K-channels to mediate the effects of endothelium-derived hyperpolarizing factor (EDHF). RESULTS Response to acetylcholine but not that to nitroprusside (endothelium-independent) was decreased in RMR. L-NAME reduced further acetylcholine relaxations in SN but not in RMR. By contrary, INDO decreased acetylcholine vasodilation in RMR but had no effect in SN. C/A had similar effects in the SN and RMR rats. The levels of 6-keto prostaglandin F1alpha were elevated in the urine of the RMR rats and were perfusate from the RMR vessels. CONCLUSION Endothelial dysfunction occurs early after RMR, even when systolic blood pressure is only minimally elevated and Na intake is normal. This alteration may be because of decreased availability of nitric oxide, partially compensated by increased prostacyclin production.
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Affiliation(s)
- S Benchetrit
- Department of Nephrology and Hypertension, Meir Hospital-Sapir Medical Center, 44281 Kfar Saba, Israel
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Svarstad E, Myking O, Ofstad J, Iversen BM. Sympathetic nervous system overactivity in hypertensive patients with chronic renal failure--role of upright body position. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2001; 35:393-400. [PMID: 11771867 DOI: 10.1080/003655901753224468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The renal functional consequences of an activated sympathetic nervous system and plasma atrial natriuretic hormone (ANP) in various renal diseases are not well described. We hypothesize that norepinephrine (NE) and ANP have antagonizing effects on renal hemodynamics in diseased kidneys. MATERIAL AND METHODS Plasma NE, ANP. glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and mean arterial pressure (MAP) were measured in the upright position in healthy controls (n = 9) and hypertensive patients with reduced GFR (n =11). The same parameters were compared between healthy controls (n = 6) and hypertensive patients with reduced GFR (n = 6) in upright and supine positions. RESULTS Upright plasma NE and ANP were significantly elevated in the patients compared with the controls (4.4 +/- 0.4 vs 2.1 +/- 0.2 nmol/l (p < 0.001) and 1.3.5 +/- 2.1 vs 6.9 +/- 1.0 nmol/l (p < 0.01) respectively). With change from upright to supine position plasma NE decreased in the controls (2.2 +/- 0.3 vs 1.7 +/- 0.3 nmol/l) (p < 0.01) and patients (3.8 +/- 0.4 vs 2.6 +/- 0.4) (p < 0.01). Supine ANP increased in controls (5.5 +/- 1.0 vs 8.3 +/- 1.1) (p < 0.01) but not in patients (14.3 +/- 3.8 vs 16.1 +/- 3.8 nmol/l) (p > 0.10). Plasma NE correlated positively with MAP (p < 0.001) and negatively with GFR (p < 0.01) in the upright but not supine position. A positive correlation between NE and ANP was observed in upright (p < 0.001) but not in supine position. ANP correlated negatively with GFR in the upright (p < 0.01) but not supine position. No position dependent changes were seen in GFR and ERPF, but supine filtration fraction (FF) increased insignificantly in the patient group (0.23 +/- 0.02 vs 0.24 +/- 0.02) (p < 0.05). CONCLUSION Hypertensive patients with reduced GFR have elevated levels of plasma NE and ANP in the upright body position. When the upright and supine positions are compared, plasma NE declines in the supine position in controls and hypertensive renal failure patients. and plasma ANP levels are elevated only in the upright position in hypertensive renal failure patients where the sympathetic nervous system is activated. A significant positive relationship between plasma NE and ANP was observed only in the upright position. The upright body position seems superior to recumbency in the characterization of these hormonal changes in hypertensive chronic renal failure patients.
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Affiliation(s)
- E Svarstad
- Renal Research Group, Institute of Medicine, University of Bergen, Norway.
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Cice G, Ferrara L, Di Benedetto A, Russo PE, Marinelli G, Pavese F, Iacono A. Dilated cardiomyopathy in dialysis patients--beneficial effects of carvedilol: a double-blind, placebo-controlled trial. J Am Coll Cardiol 2001; 37:407-11. [PMID: 11216954 DOI: 10.1016/s0735-1097(00)01158-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to investigate in dialysis patients with symptomatic heart failure New York Heart Association (NYHA) functional class II or III whether the addition of carvedilol to conventional therapy is associated with beneficial effects on cardiac architecture, function and clinical status. BACKGROUND Congestive heart failure (CHF) in chronic hemodialyzed patients, particularly when associated with dilated cardiomyopathy, represents an ominous complication and is an independent risk factor for cardiac mortality. METHODS We enrolled 114 dialysis patients with dilated cardiomyopathy. All patients were treated with carvedilol for 12 months in a double-blind, placebo-controlled, randomized trial. The patients underwent M-mode and two-dimensional echocardiography at baseline, 1, 6 and 12 months after the randomization. Each patient's clinical status was assessed using an NYHA functional classification that was determined after 6 and 12 months of treatment. RESULTS Carvedilol treatment improved left ventricular (LV) function. In the active-treatment group, the increase in LV ejection fraction (from 26.3% to 34.8%, p < 0.05 vs. basal and placebo group) and the reduction of both LV end-diastolic volume (from 100 ml/m2 to 94 ml/m2, p < 0.05 vs. basal and placebo group) and end-systolic volume (from 74 ml/m2 to 62 ml/m2, p < 0.05 vs. basal and placebo group) reached statistical significance after six months of therapy, compared with baseline and corresponding placebo values, and they remained constant at one year of treatment (p < 0.05 vs. basal and placebo group). The clinical status of patients, assessed by NYHA functional classification, improved during the treatment period. Moreover, at the end of the trial, there were no patients in NYHA functional class IV in the carvedilol group, compared with 5.9% of the patients in the placebo arm. CONCLUSIONS One year of therapy with carvedilol in dialysis patients with CHF and dilated cardiomyopathy reduces LV volumes and improves LV function and clinical status.
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Affiliation(s)
- G Cice
- Institute of Cardiovascular Clinic and Surgery, Division of Cardiology, Second University of Naples, Italy.
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Textor SC, Canzanello VJ. Importance of blood pressure reduction for prevention of progression of renal disease. Curr Hypertens Rep 1999; 1:423-30. [PMID: 10981101 DOI: 10.1007/s11906-999-0059-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite reduction of stroke and coronary mortality rates, progression of renal disease to end stage continues to occur with increasing frequency. Recent studies emphasize common pathways of elevated arterial pressures that produce increased glomerular capillary pressures and increase filtered proteins in the urinary space. Such proteinuria, along with activation of the intrarenal renin-angiotensin system, endothelin, and inflammatory cytokines, magnifies progressive renal injury and fibrosis. Malignant forms of hypertension with severe arteriolar injury and proteinuria can be treated effectively with current antihypertensive regimens with improved patient survival. Several recent studies indicate improved renal outcomes in proteinuric diseases, generally regardless of the specific antihypertensive agent. Recent trials of hypertensive subjects with minimal proteinuria demonstrate slower rates of disease progression than that seen in subjects with proteinuria above 1 gram per day. Reduction of arterial pressures, particularly when it leads to reduced proteinuria, can slow the progression of many renal diseases.
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Affiliation(s)
- S C Textor
- Division of Hypertension, Mayo Clinic, West 9A, Rochester, MN 55905, USA
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