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Kim HI, Jung DH, Lee SJ, Lee YC, Lee SK, Kim GH, Nam HJ, Lee S, Byon HJ, Shin SK. Associations between Clinicopathological Characteristics and Intraoperative Opioid Requirements during Endoscopic Submucosal Dissection with Monitored Anesthesia Care: A Retrospective Study. J Clin Med 2024; 13:3119. [PMID: 38892830 PMCID: PMC11172858 DOI: 10.3390/jcm13113119] [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: 05/09/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background and study aims: Endoscopic submucosal dissection is used to treat early gastric neoplasms. Compared with other endoscopic procedures, it requires higher doses of opioids, leading to adverse events during monitored anesthesia care. We investigated the correlations between clinicopathological characteristics and intraprocedural opioid requirements in patients who underwent endoscopic submucosal dissection under monitored anesthesia care. Patients and methods: The medical records of patients who underwent endoscopic submucosal dissection under monitored anesthesia care were retrospectively reviewed. The dependent variable was the total dose of fentanyl administered during the dissection, while independent variables were patient demographics, the American Society of Anesthesiologists physical status classification, preoperative vital sign data, and the pathological characteristics of the neoplasm. Correlations between variables were examined using multiple regression analysis. Results: The study included 743 patients. The median total fentanyl dose was 100 mcg. Younger age (coefficient -1.37; 95% confidence interval [CI] -1.78 to -0.95), male sex (16.12; 95% CI 6.99-25.24), baseline diastolic blood pressure (0.44; 95% CI 0.04-0.85), neoplasm length (1.63; 95% CI 0.90-2.36), and fibrosis (28.59; 95% CI 17.77-39.42) were positively correlated with the total fentanyl dose. Total fentanyl dose was higher in the differentiated (16.37; 95% CI 6.40-26.35) and undifferentiated cancers group (32.53; 95% CI 16.95-48.11) than in the dysplasia group; no significant differences were observed among the others. The mid-anterior wall (22.69; 95% CI 1.25-44.13), mid-posterior wall (29.65; 95% CI 14.39-44.91), mid-greater curvature (28.77; 95% CI 8.56-48.98), and upper groups (30.06; 95% CI 5.01-55.12) had higher total fentanyl doses than the lower group, whereas doses did not significantly differ for the mid-lesser curvature group. Conclusions: We identified variables that influenced opioid requirements during monitored anesthesia care for endoscopic submucosal dissection. These may help predict the needed opioid doses and identify factors affecting intraprocedural opioid requirements.
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Affiliation(s)
- Hyun Il Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Da Hyun Jung
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Sung Jin Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Yong Chan Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Ga Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Ho Jae Nam
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Sihak Lee
- Stanley Center for Psychiatric Research, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA;
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
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Chen N, Guo L, Wang L, Dai S, Zhu X, Wang E. Sleep fragmentation exacerbates myocardial ischemia‒reperfusion injury by promoting copper overload in cardiomyocytes. Nat Commun 2024; 15:3834. [PMID: 38714741 PMCID: PMC11076509 DOI: 10.1038/s41467-024-48227-y] [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] [Received: 11/16/2023] [Accepted: 04/23/2024] [Indexed: 05/10/2024] Open
Abstract
Sleep disorders increase the risk and mortality of heart disease, but the brain-heart interaction has not yet been fully elucidated. Cuproptosis is a copper-dependent type of cell death activated by the excessive accumulation of intracellular copper. Here, we showed that 16 weeks of sleep fragmentation (SF) resulted in elevated copper levels in the male mouse heart and exacerbated myocardial ischemia-reperfusion injury with increased myocardial cuproptosis and apoptosis. Mechanistically, we found that SF promotes sympathetic overactivity, increases the germination of myocardial sympathetic nerve terminals, and increases the level of norepinephrine in cardiac tissue, thereby inhibits VPS35 expression and leads to impaired ATP7A related copper transport and copper overload in cardiomyocytes. Copper overload further leads to exacerbated cuproptosis and apoptosis, and these effects can be rescued by excision of the sympathetic nerve or administration of copper chelating agent. Our study elucidates one of the molecular mechanisms by which sleep disorders aggravate myocardial injury and suggests possible targets for intervention.
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Affiliation(s)
- Na Chen
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Lizhe Guo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Sisi Dai
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaocheng Zhu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.
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Chen B, Somers VK, Sun Q, Dai Y, Li Y. Implications of sympathetic activation for objective versus self-reported daytime sleepiness in obstructive sleep apnea. Sleep 2022; 45:6562985. [PMID: 35373304 DOI: 10.1093/sleep/zsac076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/03/2022] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES Objective excessive daytime sleepiness (EDS) is associated with systemic inflammation and a higher risk of cardiometabolic morbidity in obstructive sleep apnea (OSA). We hypothesized that OSA with objective EDS is associated with higher levels of sympathetic nerve activity (SNA) when compared with self-reported EDS. We, therefore, examined the associations between objective and self-reported EDS with SNA in patients with OSA. METHODS We studied 147 consecutive male patients with OSA from the institutional sleep clinic. Objective EDS and self-reported EDS were defined based on Multiple Sleep Latency Test (MSLT) latency ≤ 8 minutes and Epworth Sleepiness Scale (ESS) > 10, respectively. Twenty-four-hour urinary norepinephrine was used for assessing SNA. Blood pressure (BP) was measured both in the evening and in the morning. RESULTS Twenty-four-hour urinary norepinephrine was significantly higher in patients with OSA with objective EDS compared with those without objective EDS (p = 0.034), whereas it was lower in patients with OSA with self-reported EDS compared with those without self-reported EDS (p = 0.038) after adjusting for confounders. Differences in the sympathetic drive were most striking in those with an objective but not self-reported EDS versus those with self-reported but not objective EDS (p = 0.002). Moreover, shorter MSLT latency was significantly associated with higher diastolic BP (β = -0.156, p = 0.049) but not systolic BP. No significant association between ESS scores and BP was observed. CONCLUSIONS Objective, but not self-reported EDS, is associated with increased SNA and diastolic BP among males with OSA, suggesting that objective EDS is a more severe phenotype of OSA that is accompanied by higher sympathetic drive, higher BP, and possibly greater cardiovascular morbidity and mortality.
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Affiliation(s)
- Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China and
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Qimeng Sun
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China and
| | - Yanyuan Dai
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China and
| | - Yun Li
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China and
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Li S, Phillips JK. Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate? Vasc Health Risk Manag 2022; 18:375-386. [PMID: 35592729 PMCID: PMC9113553 DOI: 10.2147/vhrm.s270182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Sheran Li
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Correspondence: Sheran Li, Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Yuexiu District, Guangzhou, Guangdong Province, 510120, People’s Republic of China, Tel +86 20 81332723, Fax +86 20 8133 2650, Email
| | - Jacqueline K Phillips
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Laffin LJ, Bakris GL. Catheter-Based Renal Denervation for Resistant Hypertension: Will It Ever Be Ready for "Prime Time"? Am J Hypertens 2017; 30:841-846. [PMID: 27838622 DOI: 10.1093/ajh/hpw123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/08/2016] [Indexed: 12/30/2022] Open
Abstract
The year 2014 was a turning point for the field of renal denervation (RDN) and its potential use to treat resistant hypertension. Tremendous enthusiasm shifted to sober reflection on the efficacy of a technology once touted as the cure to resistant hypertension. The following review highlights 2 major questions: First, does catheter-based RDN lower blood pressure and, second, will RDN using catheter-directed therapy for the treatment of resistant hypertension ever become more than an investigational technology.
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Affiliation(s)
- Luke J Laffin
- Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - George L Bakris
- Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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6
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Hemodynamic responses to magnetic stimulation of carotid sinus in normotensive rabbits. J Hypertens 2017; 35:1676-1684. [DOI: 10.1097/hjh.0000000000001367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Low-level carotid baroreflex stimulation suppresses atrial fibrillation by inhibiting left stellate ganglion activity in an acute canine model. Heart Rhythm 2016; 13:2203-2212. [DOI: 10.1016/j.hrthm.2016.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Indexed: 11/17/2022]
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Hildebrandt DA, Irwin ED, Lohmeier TE. Prolonged Baroreflex Activation Abolishes Salt-Induced Hypertension After Reductions in Kidney Mass. Hypertension 2016; 68:1400-1406. [PMID: 27777356 DOI: 10.1161/hypertensionaha.116.08293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/04/2016] [Accepted: 09/28/2016] [Indexed: 12/20/2022]
Abstract
Chronic electric activation of the carotid baroreflex produces sustained reductions in sympathetic activity and arterial pressure and is currently being evaluated for therapy in patients with resistant hypertension. However, patients with significant impairment of renal function have been largely excluded from clinical trials. Thus, there is little information on blood pressure and renal responses to baroreflex activation in subjects with advanced chronic kidney disease, which is common in resistant hypertension. Changes in arterial pressure and glomerular filtration rate were determined in 5 dogs after combined unilateral nephrectomy and surgical excision of the poles of the remaining kidney to produce ≈70% reduction in renal mass. After control measurements, sodium intake was increased from ≈45 to 450 mol/d. While maintained on high salt, animals experienced increases in mean arterial pressure from 102±4 to 121±6 mm Hg and glomerular filtration rate from 40±2 to 45±2 mL/min. During 7 days of baroreflex activation, the hypertension induced by high salt was abolished (103±6 mm Hg) along with striking suppression of plasma norepinephrine concentration from 139±21 to 81±9 pg/mL, but despite pronounced blood pressure lowering, there were no significant changes in glomerular filtration rate (43±2 mL/min). All variables returned to prestimulation values during a recovery period. These findings indicate that after appreciable nephron loss, chronic suppression of central sympathetic outflow by baroreflex activation abolishes hypertension induced by high salt intake. The sustained antihypertensive effects of baroreflex activation occur without significantly compromising glomerular filtration rate in remnant nephrons.
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Affiliation(s)
- Drew A Hildebrandt
- From the Department of Physiology and Biophysics (D.A.H., T.E.L.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; and Trauma Services, North Memorial Medical Center, Robbinsdale, MN (E.D.I.)
| | - Eric D Irwin
- From the Department of Physiology and Biophysics (D.A.H., T.E.L.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; and Trauma Services, North Memorial Medical Center, Robbinsdale, MN (E.D.I.)
| | - Thomas E Lohmeier
- From the Department of Physiology and Biophysics (D.A.H., T.E.L.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; and Trauma Services, North Memorial Medical Center, Robbinsdale, MN (E.D.I.).
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9
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Fatemi O, Goa C, Faselis C, Kokkinos P, Papademetriou V. Improvement in All-Cause Mortality With Blood Pressure Control in a Group of US Veterans With Drug-Resistant Hypertension. J Clin Hypertens (Greenwich) 2016; 18:33-9. [PMID: 26440866 PMCID: PMC8031702 DOI: 10.1111/jch.12672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/01/2015] [Accepted: 07/05/2015] [Indexed: 08/10/2024]
Abstract
The current definition of drug-resistant hypertension includes patients with uncontrolled (URH) (taking ≥3 antihypertensive medications) and controlled hypertension (CRH; blood pressure [BP] ≤140/90 mm Hg) (taking ≥4 medications). The authors hypothesized that all-cause mortality is reduced when URH is controlled. Qualified patients followed at the Washington DC VA Medical Center were included. BPs were averaged for each year of follow-up. In 2006, among 2906 patients who met the criteria for drug-resistant hypertension, 628 had URH. During follow-up, 234 patients were controlled (group 1) and 394 patients remained uncontrolled (group 2). The mortality rate among patients with URH was 28% (110 of 394) and among patients with CRH was 13% (30 of 234), a 54% reduction (P<.01). Multivariate analysis identified independent predictors of mortality as uncontrolled HTN (hazard ratio, 2.5; 95% confidence interval, 1.67-3.75; P<.01), age (hazard ratio, 1.03; 95% confidence interval, 1.01-1.04; P<.01), and diabetes (hazard ratio, 1.46; 95% confidence interval, 1.04-2.05; P<.027). The authors conclude that controlling drug-resistant hypertension markedly reduces all-cause mortality.
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Affiliation(s)
- Omid Fatemi
- George Washington University HospitalWashingtonDC
- Georgetown University HospitalWashingtonDC
- Veterans Affairs Medical CenterWashingtonDC
- Washington Hospital CenterWashingtonDC
| | - Cristobal Goa
- Georgetown University HospitalWashingtonDC
- Veterans Affairs Medical CenterWashingtonDC
- Washington Hospital CenterWashingtonDC
| | - Charles Faselis
- Veterans Affairs Medical CenterWashingtonDC
- George Washington University School of MedicineWashingtonDC
| | - Peter Kokkinos
- Veterans Affairs Medical CenterWashingtonDC
- George Washington University School of MedicineWashingtonDC
- Georgetown University School of MedicineWashingtonDC
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Turner MJ, Kawada T, Shimizu S, Fukumitsu M, Sugimachi M. Differences in the dynamic baroreflex characteristics of unmyelinated and myelinated central pathways are less evident in spontaneously hypertensive rats. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1397-405. [DOI: 10.1152/ajpregu.00315.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022]
Abstract
The aim of the study was to identify the contribution of myelinated (A-fiber) and unmyelinated (C-fiber) baroreceptor central pathways to the baroreflex control of sympathetic nerve activity (SNA) and arterial pressure (AP) in anesthetized Wistar-Kyoto (WKY; n = 8) and spontaneously hypertensive rats (SHR; n = 8). The left aortic depressor nerve (ADN) was electrically stimulated with two types of binary white noise signals designed to preferentially activate A-fibers (A-BRx protocol) or C-fibers (C-BRx protocol). In WKY, the central arc transfer function from ADN stimulation to SNA estimated by A-BRx showed strong derivative characteristics with the slope of dynamic gain between 0.1 and 1 Hz ( Gslope) of 14.63 ± 0.89 dB/decade. In contrast, the central arc transfer function estimated by C-BRx exhibited nonderivative characteristics with Gslope of 0.64 ± 1.13 dB/decade. This indicates that A-fibers are important for rapid baroreflex regulation, whereas C-fibers are likely important for more sustained regulation of SNA and AP. In SHR, the central arc transfer function estimated by A-BRx showed higher Gslope (18.46 ± 0.75 dB/decade, P < 0.01) and that estimated by C-BRx showed higher Gslope (8.62 ± 0.64 dB/decade, P < 0.001) with significantly lower dynamic gain at 0.01 Hz (6.29 ± 0.48 vs. 2.80 ± 0.36%/Hz, P < 0.001) compared with WKY. In conclusion, the dynamic characteristics of the A-fiber central pathway are enhanced in the high-modulation frequency range (0.1–1 Hz) and those of the C-fiber central pathway are attenuated in the low-modulation frequency range (0.01–0.1 Hz) in SHR.
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Affiliation(s)
- Michael J. Turner
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan; and
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan; and
| | - Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan; and
| | - Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan; and
- Department of Artificial Organ Medicine, Faculty of Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan; and
- Department of Artificial Organ Medicine, Faculty of Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Iliescu R, Lohmeier TE, Tudorancea I, Laffin L, Bakris GL. Renal denervation for the treatment of resistant hypertension: review and clinical perspective. Am J Physiol Renal Physiol 2015. [PMID: 26224718 DOI: 10.1152/ajprenal.00246.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
When introduced clinically 6 years ago, renal denervation was thought to be the solution for all patients whose blood pressure could not be controlled by medication. The initial two studies, SYMPLICITY HTN-1 and HTN-2, demonstrated great magnitudes of blood pressure reduction within 6 mo of the procedure and were based on a number of assumptions that may not have been true, including strict adherence to medication and absence of white-coat hypertension. The SYMPLICITY HTN-3 trial controlled for all possible factors believed to influence the outcome, including the addition of a sham arm, and ultimately proved the demise of the initial overly optimistic expectations. This trial yielded a much lower blood pressure reduction compared with the previous SYMPLICITY trials. Since its publication in 2014, there have been many analyses to try and understand what accounted for the differences. Of all the variables examined that could influence blood pressure outcomes, the extent of the denervation procedure was determined to be inadequate. Beyond this, the physiological mechanisms that account for the heterogeneous fall in arterial pressure following renal denervation remain unclear, and experimental studies indicate dependence on more than simply reduced renal sympathetic activity. These and other related issues are discussed in this paper. Our perspective is that renal denervation works if done properly and used in the appropriate patient population. New studies with new approaches and catheters and appropriate controls will be starting later this year to reassess the efficacy and safety of renal denervation in humans.
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Affiliation(s)
- Radu Iliescu
- Department of Physiology, University of Medicine and Pharmacy, "Gr. T. Popa," Iasi, Romania
| | - Thomas E Lohmeier
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Ionut Tudorancea
- Department of Physiology, University of Medicine and Pharmacy, "Gr. T. Popa," Iasi, Romania
| | - Luke Laffin
- Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, Illinois
| | - George L Bakris
- Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, Illinois
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Lohmeier TE, Liu B, Hildebrandt DA, Cates AW, Georgakopoulos D, Irwin ED. Global- and renal-specific sympathoinhibition in aldosterone hypertension. Hypertension 2015; 65:1223-30. [PMID: 25895584 DOI: 10.1161/hypertensionaha.115.05155] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/12/2015] [Indexed: 12/27/2022]
Abstract
Recent technology for chronic electric activation of the carotid baroreflex and renal nerve ablation provide global and renal-specific suppression of sympathetic activity, respectively, but the conditions for favorable antihypertensive responses in resistant hypertension are unclear. Because inappropriately high plasma levels of aldosterone are prevalent in these patients, we investigated the effects of baroreflex activation and surgical renal denervation in dogs with hypertension induced by chronic infusion of aldosterone (12 μg/kg per day). Under control conditions, basal values for mean arterial pressure and plasma norepinephrine concentration were 100±3 mm Hg and 134±26 pg/mL, respectively. By day 7 of baroreflex activation, plasma norepinephrine was reduced by ≈40% and arterial pressure by 16±2 mm Hg. All values returned to control levels during the recovery period. Arterial pressure increased to 122±5 mm Hg concomitant with a rise in plasma aldosterone concentration from 4.3±0.4 to 70.0±6.4 ng/dL after 14 days of aldosterone infusion, with no significant effect on plasma norepinephrine. After 7 days of baroreflex activation at control stimulation parameters, the reduction in plasma norepinephrine was similar but the fall in arterial pressure (7±1 mm Hg) was diminished (≈55%) during aldosterone hypertension when compared with control conditions. Despite sustained suppression of sympathetic activity, baroreflex activation did not have central actions to inhibit either the stimulation of vasopressin secretion or drinking induced by increased plasma osmolality during chronic aldosterone infusion. Finally, renal denervation did not attenuate aldosterone hypertension. These findings suggest that aldosterone excess may portend diminished blood pressure lowering to global and especially renal-specific sympathoinhibition during device-based therapy.
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Affiliation(s)
- Thomas E Lohmeier
- From the Department of Physiology and Biophysics (T.E.L., B.L., D.A.H.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; CVRx, Inc., Minneapolis, MN (A.W.C., D.G.); and North Memorial Medical Center, Trauma Services, Robbinsdale, MN (E.D.I.).
| | - Boshen Liu
- From the Department of Physiology and Biophysics (T.E.L., B.L., D.A.H.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; CVRx, Inc., Minneapolis, MN (A.W.C., D.G.); and North Memorial Medical Center, Trauma Services, Robbinsdale, MN (E.D.I.)
| | - Drew A Hildebrandt
- From the Department of Physiology and Biophysics (T.E.L., B.L., D.A.H.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; CVRx, Inc., Minneapolis, MN (A.W.C., D.G.); and North Memorial Medical Center, Trauma Services, Robbinsdale, MN (E.D.I.)
| | - Adam W Cates
- From the Department of Physiology and Biophysics (T.E.L., B.L., D.A.H.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; CVRx, Inc., Minneapolis, MN (A.W.C., D.G.); and North Memorial Medical Center, Trauma Services, Robbinsdale, MN (E.D.I.)
| | - Dimitrios Georgakopoulos
- From the Department of Physiology and Biophysics (T.E.L., B.L., D.A.H.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; CVRx, Inc., Minneapolis, MN (A.W.C., D.G.); and North Memorial Medical Center, Trauma Services, Robbinsdale, MN (E.D.I.)
| | - Eric D Irwin
- From the Department of Physiology and Biophysics (T.E.L., B.L., D.A.H.) and Department of Surgery (D.A.H.), University of Mississippi Medical Center, Jackson; CVRx, Inc., Minneapolis, MN (A.W.C., D.G.); and North Memorial Medical Center, Trauma Services, Robbinsdale, MN (E.D.I.)
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Abstract
Because of resetting, a role for baroreflexes in long-term control of arterial pressure has been commonly dismissed in the past. However, in recent years, this perspective has changed. Novel approaches for determining chronic neurohormonal and cardiovascular responses to natural variations in baroreceptor activity and to electrical stimulation of the carotid baroreflex indicate incomplete resetting and sustained responses that lead to long-term alterations in sympathetic activity and arterial pressure.
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Affiliation(s)
- Thomas E Lohmeier
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Radu Iliescu
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi; and Department of Physiology, University of Medicine and Pharmacology, Gr. T. Popa, Iasi, Romania
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14
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Sata Y, Kawada T, Shimizu S, Kamiya A, Akiyama T, Sugimachi M. Predominant role of neural arc in sympathetic baroreflex resetting of spontaneously hypertensive rats. Circ J 2014; 79:592-9. [PMID: 25746544 DOI: 10.1253/circj.cj-14-1013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is ongoing controversy over whether neural or peripheral factors are the predominant cause of hypertension. The closed-loop negative feedback operation of the arterial baroreflex hampers understanding of how arterial pressure (AP) is determined through the interaction between neural and peripheral factors. METHODS AND RESULTS: A novel analysis of an isolated open-loop baroreceptor preparation to examine sympathetic nervous activity (SNA) and AP responses to changes in carotid sinus pressure (CSP) in adult spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY) was conducted. In the neural arc (CSP-SNA relationship), the midpoint pressure (128.9±3.8 vs. 157.9±8.1 mmHg, P<0.001) and the response range of SNA to CSP (90.5±3.7 vs. 115.4±7.6%/mmHg, P=0.011) were higher in SHR. In the peripheral arc (SNA-AP relationship), slope and intercept did not differ. A baroreflex equilibrium diagram was obtained by depicting neural and peripheral arcs in a pressure-SNA plane with rescaled SNA (% in WKY). The operating-point AP (111.3±4.4 vs. 145.9±5.2 mmHg, P<0.001) and SNA (90.8±3.2 vs. 125.1±6.9% in WKY, P<0.001) were shifted towards a higher level in SHR. CONCLUSIONS The shift of the neural arc towards a higher SNA range indicated a predominant contribution to baroreflex resetting in SHR. Notwithstanding the resetting, the carotid sinus baroreflex in SHR preserved an ability to reduce AP if activated with a high enough pressure.
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Affiliation(s)
- Yusuke Sata
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center; Department of Artificial Organ Medicine, Faculty of Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
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15
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Mugabo P, Philander A, Raji I, Dietrich D, Green I. Effects of hippadine on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats. JOURNAL OF ETHNOPHARMACOLOGY 2014; 158 Pt A:123-131. [PMID: 25456427 DOI: 10.1016/j.jep.2014.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/01/2014] [Accepted: 10/11/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Hippadine is an alkaloid isolated from Crinum macowanii. Crinum macowanii is used in South Africa to treat oedema, 'heart disease', rheumatic fever, cancer and skin diseases, and belongs to the plant family Amaryllidaceae, assumed to have originated in the South African region. The aim of this study was to evaluate the effect of hippadine, an alkaloid extracted from Crinum macowanii, on the blood pressure (BP) and heart rate (HR) in anaesthetized male spontaneously hypertensive Wistar rats (SHR); and to find out if α1 and⧸or β1 adrenoceptors contribute to its effects. MATERIALS AND METHODS Hippadine (2.5-12.5mg/kg), adrenaline (0.05-0.20mg/kg), atenolol (0.5-40mg/kg) and prazosin hydrochloride (100-500µg/kg) were infused intravenously, and the BP and HR measured via a pressure transducer connecting the femoral artery and the PowerLab. Adrenaline increased the systolic, diastolic and mean arterial BP, while hippadine, atenolol and prazosin respectively decreased the systolic, diastolic and mean arterial BP. Increases in HR were observed with both adrenaline and prazosin, while reductions in HR were observed with atenolol and hippadine. Infusion of adrenaline in rats pre-treated with atenolol (30mg/kg), prazosin (400µg/kg), and hippadine (10mg/kg) led to similar increases in BP and HR in all groups. All changes in HR or BP were significant (p<0.05) and dose dependent. CONCLUSION Hippadine decreases the BP and HR in SHR, and these effects may be due to α1 and β1 adrenoceptor inhibition.
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Affiliation(s)
- Pierre Mugabo
- School of Pharmacy, University of the Western Cape, South Africa.
| | | | - Ismaila Raji
- Faculty of Medicine, National University of Science and Technology, Zimbabwe
| | - Daneel Dietrich
- Department of Medical Biosciences, University of the Western Cape, South Africa
| | - Ivan Green
- Department of Chemistry, University of the Western Cape, South Africa
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16
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Goldstein DS. Concepts of scientific integrative medicine applied to the physiology and pathophysiology of catecholamine systems. Compr Physiol 2014; 3:1569-610. [PMID: 24265239 DOI: 10.1002/cphy.c130006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review presents concepts of scientific integrative medicine and relates them to the physiology of catecholamine systems and to the pathophysiology of catecholamine-related disorders. The applications to catecholamine systems exemplify how scientific integrative medicine links systems biology with integrative physiology. Concepts of scientific integrative medicine include (i) negative feedback regulation, maintaining stability of the body's monitored variables; (ii) homeostats, which compare information about monitored variables with algorithms for responding; (iii) multiple effectors, enabling compensatory activation of alternative effectors and primitive specificity of stress response patterns; (iv) effector sharing, accounting for interactions among homeostats and phenomena such as hyperglycemia attending gastrointestinal bleeding and hyponatremia attending congestive heart failure; (v) stress, applying a definition as a state rather than as an environmental stimulus or stereotyped response; (vi) distress, using a noncircular definition that does not presume pathology; (vii) allostasis, corresponding to adaptive plasticity of feedback-regulated systems; and (viii) allostatic load, explaining chronic degenerative diseases in terms of effects of cumulative wear and tear. From computer models one can predict mathematically the effects of stress and allostatic load on the transition from wellness to symptomatic disease. The review describes acute and chronic clinical disorders involving catecholamine systems-especially Parkinson disease-and how these concepts relate to pathophysiology, early detection, and treatment and prevention strategies in the post-genome era.
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Affiliation(s)
- David S Goldstein
- Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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17
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Iliescu R, Tudorancea I, Lohmeier TE. Baroreflex activation: from mechanisms to therapy for cardiovascular disease. Curr Hypertens Rep 2014; 16:453. [PMID: 24899538 PMCID: PMC4364442 DOI: 10.1007/s11906-014-0453-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent technical advances have led to the development of a medical device that can reliably activate the carotid baroreflex with an acceptable degree of safety. Because activation of the sympathetic nervous system plays an important role in the pathogenesis of hypertension and heart failure, the unique ability of this device to chronically suppress central sympathetic outflow in a controlled manner suggests potential value in the treatment of these conditions. This notion is supported by both clinical and experimental animal studies, and the major aim of this article is to elucidate the physiological mechanisms that account for the favorable effects of baroreflex activation therapy in patients with resistant hypertension and heart failure. Illumination of the neurohormonal, renal, and cardiac actions of baroreflex activation is likely to provide the means for better identification of those patients that are most likely to respond favorably to this device-based therapy.
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Affiliation(s)
- Radu Iliescu
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State St., Jackson, MS, 39216-4505, USA,
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18
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Hao C, Huang ZH, Song SW, Shi YQ, Cheng XW, Murohara T, Lu W, Su DF, Duan JL. Arterial baroreflex dysfunction impairs ischemia-induced angiogenesis. J Am Heart Assoc 2014; 3:e000804. [PMID: 24820655 PMCID: PMC4309071 DOI: 10.1161/jaha.114.000804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Endothelium‐derived acetylcholine (eACh) plays an important role in the regulation of vascular actions in response to hypoxia, whereas arterial baroreflex (ABR) dysfunction impairs the eACh system. We investigated the effects of ABR dysfunction on ischemia‐induced angiogenesis in animal models of hindlimb ischemia with a special focus on eACh/nicotinic ACh receptor (nAChR) signaling activation. Methods and Results Male Sprague‐Dawley rats were randomly assigned to 1 of 3 groups that received (1) sham operation (control group), (2) sinoaortic denervation (SAD)‐induced ABR dysfunction (SAD group), or (3) SAD rats on diet with an acetylcholinesterase inhibitor pyridostigmine (30 mg/kg per day, SAD+Pyr group). After 4 weeks of the SAD intervention, unilateral limb ischemia was surgically induced in all animals. At postoperative day 14, SAD rats exhibited impaired angiogenic action (skin temperature and capillary density) and decreased angiogenic factor expressions (vascular endothelial growth factor [VEGF] and hypoxic inducible factor [HIF]‐1α) in ischemic muscles. These changes were restored by acetylcholinesterase inhibition. Rats with ABR dysfunction had lower eACh levels than did control rats, and this effect was recovered in SAD+Pyr rats. In α7‐nAChR knockout mice, pyridostigmine improved ischemia‐induced angiogenic responses and increased the levels of VEGF and HIF‐1α. Moreover, nicotinic receptor blocker inhibited VEGF expression and VEGF receptor 2 phosphorylation (p‐VEGFR2) induced by ACh analog. Conclusions Thus, ABR dysfunction appears to impair ischemia‐induced angiogenesis through the reduction of eACh/α7‐nAChR‐dependent and ‐independent HIF‐1α/VEGF‐VEGFR2 signaling activation.
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Affiliation(s)
- Changning Hao
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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19
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Beard DA, Pettersen KH, Carlson BE, Omholt SW, Bugenhagen SM. A computational analysis of the long-term regulation of arterial pressure. F1000Res 2013; 2:208. [PMID: 24555102 DOI: 10.12688/f1000research.2-208.v1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 12/25/2022] Open
Abstract
The asserted dominant role of the kidneys in the chronic regulation of blood pressure and in the etiology of hypertension has been debated since the 1970s. At the center of the theory is the observation that the acute relationships between arterial pressure and urine production-the acute pressure-diuresis and pressure-natriuresis curves-physiologically adapt to perturbations in pressure and/or changes in the rate of salt and volume intake. These adaptations, modulated by various interacting neurohumoral mechanisms, result in chronic relationships between water and salt excretion and pressure that are much steeper than the acute relationships. While the view that renal function is the dominant controller of arterial pressure has been supported by computer models of the cardiovascular system known as the "Guyton-Coleman model", no unambiguous description of a computer model capturing chronic adaptation of acute renal function in blood pressure control has been presented. Here, such a model is developed with the goals of: 1. representing the relevant mechanisms in an identifiable mathematical model; 2. identifying model parameters using appropriate data; 3. validating model predictions in comparison to data; and 4. probing hypotheses regarding the long-term control of arterial pressure and the etiology of primary hypertension. The developed model reveals: long-term control of arterial blood pressure is primarily through the baroreflex arc and the renin-angiotensin system; and arterial stiffening provides a sufficient explanation for the etiology of primary hypertension associated with ageing. Furthermore, the model provides the first consistent explanation of the physiological response to chronic stimulation of the baroreflex.
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Affiliation(s)
- Daniel A Beard
- Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Klas H Pettersen
- Department of Mathematical and Technological Sciences, Norwegian University of Life Science, Oslo, Norway
| | - Brian E Carlson
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Stig W Omholt
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Scott M Bugenhagen
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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20
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Beard DA, Pettersen KH, Carlson BE, Omholt SW, Bugenhagen SM. A computational analysis of the long-term regulation of arterial pressure. F1000Res 2013; 2:208. [PMID: 24555102 PMCID: PMC3886803 DOI: 10.12688/f1000research.2-208.v2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 01/08/2023] Open
Abstract
The asserted dominant role of the kidneys in the chronic regulation of blood pressure and in the etiology of hypertension has been debated since the 1970s. At the center of the theory is the observation that the acute relationships between arterial pressure and urine production—the acute pressure-diuresis and pressure-natriuresis curves—physiologically adapt to perturbations in pressure and/or changes in the rate of salt and volume intake. These adaptations, modulated by various interacting neurohumoral mechanisms, result in chronic relationships between water and salt excretion and pressure that are much steeper than the acute relationships. While the view that renal function is the dominant controller of arterial pressure has been supported by computer models of the cardiovascular system known as the “Guyton-Coleman model”, no unambiguous description of a computer model capturing chronic adaptation of acute renal function in blood pressure control has been presented. Here, such a model is developed with the goals of: 1. representing the relevant mechanisms in an identifiable mathematical model; 2. identifying model parameters using appropriate data; 3. validating model predictions in comparison to data; and 4. probing hypotheses regarding the long-term control of arterial pressure and the etiology of primary hypertension. The developed model reveals: long-term control of arterial blood pressure is primarily through the baroreflex arc and the renin-angiotensin system; and arterial stiffening provides a sufficient explanation for the etiology of primary hypertension associated with ageing. Furthermore, the model provides the first consistent explanation of the physiological response to chronic stimulation of the baroreflex.
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Affiliation(s)
- Daniel A Beard
- Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Klas H Pettersen
- Department of Mathematical and Technological Sciences, Norwegian University of Life Science, Oslo, Norway
| | - Brian E Carlson
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Stig W Omholt
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Scott M Bugenhagen
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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21
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Abstract
Abundant evidence supports a role of the sympathetic nervous system in the pathogenesis of obesity-related hypertension. However, the nature and temporal progression of mechanisms underlying this sympathetically mediated hypertension are incompletely understood. Recent technological advances allowing direct recordings of renal sympathetic nerve activity (RSNA) in conscious animals, together with direct suppression of RSNA by renal denervation and reflex-mediated global sympathetic inhibition in experimental animals and human subjects have been especially valuable in elucidating these mechanisms. These studies strongly support the concept that increased RSNA is the critical mechanism by which increased central sympathetic outflow initiates and maintains reductions in renal excretory function, causing obesity hypertension. Potential determinants of renal sympathoexcitation and the differential mechanisms mediating the effects of renal-specific versus reflex-mediated, global sympathetic inhibition on renal hemodynamics and cardiac autonomic function are discussed. These differential mechanisms may impact the efficacy of current device-based approaches for hypertension therapy.
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Affiliation(s)
- Thomas E. Lohmeier
- Department of Physiology & Biophysics University of Mississippi Medical Center Jackson, MS
| | - Radu Iliescu
- Department of Physiology & Biophysics University of Mississippi Medical Center Jackson, MS
- Department of Physiology University of Medicine and Pharmacy, “Gr. T. Popa” Iasi, Romania
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22
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Alnima T, de Leeuw PW, Tan FES, Kroon AA. Renal responses to long-term carotid baroreflex activation therapy in patients with drug-resistant hypertension. Hypertension 2013; 61:1334-9. [PMID: 23589562 DOI: 10.1161/hypertensionaha.113.01159] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid baroreflex activation has been demonstrated to provide enduring reductions in arterial blood pressure. The aim of this study was to investigate the effect of long-term therapy on renal function. A total of 322 patients were enrolled in the Rheos Pivotal Trial. Group 1 consisted of 236 patients who started baroreflex activation therapy 1 month after device implantation, whereas in the 86 patients from group 2 the device was activated 6 months later. Serum creatinine and urine albumin/creatinine ratio were collected at screening (before device activation), and at months 6 and 12. Multilevel statistical analyses were adjusted for various covariables. Serum creatinine increased from 78 to 84 μmol/L, and glomerular filtration rate decreased from 92 to 87 mL/min per 1.73 m(2) in group 1 at month 6 (P<0.05). These values did not change any further after 12 months of therapy. Patients with highest glomerular filtration rate showed the greatest decrease in glomerular filtration. Group 2 showed the same trends as group 1 even before device activation at month 6. Systolic blood pressure reduction seemed to be significantly related to the change in glomerular filtration rate in both groups. Albumin/creatinine ratio did not change in both groups during follow-up. In conclusion, baroreflex activation therapy in hypertensive patients is associated with an initial mild decrease in glomerular filtration rate, which may be considered as a normal hemodynamic response to the drop in blood pressure. Long-term treatment does not result in further decrease in renal function, indicating baroreflex activation as a safe and effective therapy.
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Affiliation(s)
- Teba Alnima
- Department of Internal Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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23
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Joyner MJ, Limberg JK. Blood pressure regulation: every adaptation is an integration? Eur J Appl Physiol 2013; 114:445-50. [PMID: 23558925 DOI: 10.1007/s00421-013-2636-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/25/2013] [Indexed: 11/25/2022]
Abstract
This focused review serves to explore relevant issues in regard to blood pressure regulation and by doing so, provides the initial stimulus paper for the Thematic Review series "Blood Pressure Regulation" to be published in the European Journal of Applied Physiology over the coming months. In this introduction, we highlight how variable normal blood pressure can be and challenge the reader to take another look at some key concepts related to blood pressure regulation. We point out that there is frequently an underappreciated balance between peripheral vasodilation and systemic blood pressure regulation and ask the question: are changes in blood pressure, in effect, reasonable and integrated adaptations to the physiological challenge at hand? We conclude with the idea that blood pressure regulatory systems are both flexible and redundant; ensuring a wide variety of activities associated with life can be accompanied by a perfusion pressure that can serve multiple masters.
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Affiliation(s)
- Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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24
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Affiliation(s)
- Gerald F DiBona
- Department of Internal Medicine and Molecular Physiology and Biophysics, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
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