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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 2024:10.1038/s41440-024-01704-9. [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] [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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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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Armario P, Avellaneda-Gómez C, Gómez-Choco M. Early Detection and Treatment of Hypertension and Obstructive Sleep Apnoea: Can We Prevent the Progression of Small Vessel Cerebrovascular Disease? Arch Bronconeumol 2024; 60:77-79. [PMID: 38052680 DOI: 10.1016/j.arbres.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Pedro Armario
- Cardiovascular Risk Area, Complex Hospitalari Universitari Moisès Broggi, Spain; Universitat de Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Spain.
| | - Carla Avellaneda-Gómez
- Cardiovascular Risk Area, Complex Hospitalari Universitari Moisès Broggi, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Spain; Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Spain
| | - Manuel Gómez-Choco
- Cardiovascular Risk Area, Complex Hospitalari Universitari Moisès Broggi, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Spain; Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Spain
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Grassi G, Mancia G. New European Guidelines 2023 for Hypertension: When and Why Should We Think About Sleep Apnea? Arch Bronconeumol 2024; 60:73-74. [PMID: 37985281 DOI: 10.1016/j.arbres.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy.
| | - Giuseppe Mancia
- Professor Emeritus, University of Milan Bicocca, Milan, Italy
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Grassi G, Dell'Oro R, Quarti-Trevano F, Vanoli J, Oparil S. Sympathetic Neural Mechanisms in Hypertension: Recent Insights. Curr Hypertens Rep 2023; 25:263-270. [PMID: 37450271 PMCID: PMC10505104 DOI: 10.1007/s11906-023-01254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW To examine published and unpublished data documenting the role of sympathetic neural factors in the pathogenesis of different hypertensive phenotypes. These phenotypes relate to attended or unattended blood pressure measurements, to nighttime blood pressure profile alterations, and to resistant, pseudoresistant, and refractory hypertension. Results of original clinical studies as well as of recent meta-analyses based on the behavior of different sympathetic biomarkers in various hypertensive forms will be also discussed. RECENT FINDINGS Studies performed in the past decade have shown that office blood pressure measurements, including in recent years those characterizing unattended or attended blood pressure assessment, are associated with profound changes in the behavior of different sympathetic biomarkers. This is the case for the clinical hypertensive phenotypes characterized by alterations in the nocturnal blood pressure profile and by sleep duration abnormalities. This is also the case for the clinical conditions defined as resistant, refractory, and pseudoresistant hypertension. Data reviewed in the present paper highlight the relevance of sympathetic neural factors in the development and progression of different clinical hypertensive phenotypes. This suggests that a common hallmark of the majority of the essential hypertensive states detectable in current clinical practice is represented by the alteration in the sympathetic blood pressure control.
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Affiliation(s)
- Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Milan, Italy.
| | - Raffaella Dell'Oro
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Milan, Italy
| | - Fosca Quarti-Trevano
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Milan, Italy
| | - Jennifer Vanoli
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Milan, Italy
| | - Suzanne Oparil
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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Biffi A, Dell'Oro R, Quarti-Trevano F, Cuspidi C, Corrao G, Mancia G, Grassi G. Effects of Renal Denervation on Sympathetic Nerve Traffic and Correlates in Drug-Resistant and Uncontrolled Hypertension: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:659-667. [PMID: 36628971 DOI: 10.1161/hypertensionaha.122.20503] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Whether and to what extent the reported blood pressure (BP) lowering effects of renal denervation (RDN) are associated with a central sympathoinhibition is controversial. We examined this issue by performing a meta-analysis of the microneurographic studies evaluating the BP and muscle sympathetic nerve activity (MSNA) responses to RDN in drug-resistant or uncontrolled hypertension (RHT). METHODS This analysis comprised 11 studies including a total of >400 RHT patients undergoing RDN and were followed up for 6 months. Evaluation was extended to the relationships of MSNA with clinic heart rate and BP changes associated with RDN. RESULTS MSNA showed a significant reduction after RDN (-4.78 bursts/100 heart beats; P<0.04), which was also accompanied by a significant systolic (-11.45 mm Hg; P<0.002) and diastolic (-5.24 mm Hg; P=0.0001) BP decrease. No significant quantitative relationship was found between MSNA and systolic (r=-0.96, P=0.19) or diastolic BP (r=-0.97, P=0.23) responses to RDN. This was also the case for clinic heart rate (r=0.53, P=0.78, respectively), whose post RDN values were not significant different from the pre-RDN ones. More than 10 renal nerves ablations were found to be needed for obtaining a significant sympathoinhibition. CONCLUSIONS This meta-analysis, the first ever done on the MSNA responses to RDN, shows that in a consistent number of RHT patients RDN is associated with a significant, although modest, central sympathoinhibition, which appears to be unrelated to the BP lowering effects of the procedure. Thus factors other than the central sympathetic outflow inhibition may concur at the BP lowering effects of RDN.
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Affiliation(s)
- Annalisa Biffi
- Department of Statistics and Quantitative Methods (A.B., G.C.), University Milano-Bicocca, Italy.,Na-National Centre for Healthcare Research and Pharmacoepidemiology (A.B., G.C.), University Milano-Bicocca, Italy
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery (R.D.O., F.Q.-T., C.C., G.M., G.G.), University Milano-Bicocca, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery (R.D.O., F.Q.-T., C.C., G.M., G.G.), University Milano-Bicocca, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery (R.D.O., F.Q.-T., C.C., G.M., G.G.), University Milano-Bicocca, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods (A.B., G.C.), University Milano-Bicocca, Italy.,Na-National Centre for Healthcare Research and Pharmacoepidemiology (A.B., G.C.), University Milano-Bicocca, Italy
| | - Giuseppe Mancia
- Clinica Medica, Department of Medicine and Surgery (R.D.O., F.Q.-T., C.C., G.M., G.G.), University Milano-Bicocca, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (R.D.O., F.Q.-T., C.C., G.M., G.G.), University Milano-Bicocca, Italy
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Neuroadrenergic activation in obstructive sleep apnoea syndrome: a new selected meta-analysis – revisited: Erratum. J Hypertens 2022; 40:2321. [DOI: 10.1097/hjh.0000000000003303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gherbesi E, Tadic M, Faggiano A, Sala C, Carugo S, Cuspidi C. Sleep Apnea Syndrome and Large Artery Subclinical Damage: Targeting Thoracic Aortic Dilatation. Am J Hypertens 2022; 35:543-550. [PMID: 35136923 DOI: 10.1093/ajh/hpac006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/31/2021] [Accepted: 02/02/2022] [Indexed: 01/27/2023] Open
Abstract
AIM Whether obstructive sleep apnea (OSA) actually represents an independent risk factor for aortic dilation in the general population is unclear. We investigated this issue through a review and a meta-analysis of cardiac imaging studies that provided data on this vascular phenotype measured at the root or ascending tract level. DESIGN A computerized search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 30 November 2021. Studies were identified by using the following search terms: "aortic root," "ascending aorta," "vascular damage," "echocardiography," "computed tomography," "magnetic resonance imaging," "obstructive sleep apnea," "sleep disordered breathing." RESULTS Eleven studies including a total of 1,860 patients with OSA (without aortic aneurysms and connective tissue diseases) and 233 non-OSA controls were considered. Aortic diameter was significantly higher in patients with OSA than in non-OSA controls (standard means difference [SMD] = 0.73 ± 0.08, confidence interval [CI]: 0.57-0.88, P < 0.0001). This was also the case for patients with severe OSA as compared with their counterparts with mild OSA (SMD = 0.42 ± 0.07, CI: 0.28-0.56, P < 0.0001). CONCLUSIONS Our findings suggest an association between OSA and aortic enlargement and particularly in the severe OSA setting. However, this conclusion must be taken with caution in relation to 2 types of factors: (i) the paucity of available data, and (ii) the limits deriving from the methodological differences of the various studies. Larger prospective and carefully designed studies are needed to shed light on this relevant public health topic.
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Affiliation(s)
- Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Marijana Tadic
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Cesare Cuspidi
- University Clinical Hospital Centre "DragisaMisovic", Belgrade, Serbia
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Sympathetic activation by obstructive sleep apnea: a challenging 'off-label' meta-analysis. J Hypertens 2022; 40:30-32. [PMID: 34857703 DOI: 10.1097/hjh.0000000000003058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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