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Cited by 146Blood Pressure and Hypertension StudiesHeart Rate Variability and Autonomic ControlCardiovascular Syncope and Autonomic Disorders

Sympathetic neural mechanisms in white-coat hypertension

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Smith, Paul A, Graham, Lee N, Mackintosh, Alan F, Stoker, John B, Mary, David A.S.G·2002·Journal of the American College of Cardiology
DOI 10.1016/s0735-1097(02)01931-9
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Abstract

Objectives This study planned to establish whether sympathetic hyperactivity exists in white-coat hypertension (WHT) in the clinical setting, relative to matched groups with normotension (NT) and untreated essential hypertension (EHT).Background White-coat hypertension differs from EHT by the presence of normal ambulatory blood pressure. Sympathetic hyperactivity exists in patients with EHT in the clinical setting and is believed to contribute to the development of target organ damage. Similar organ damage has been reported in WHT, yet little is known about sympathetic neural activity in this condition.Methods Using microneurography, we examined groups of 12 matched subjects with WHT, EHT and NT during the same clinical setting to quantify muscle sympathetic nerve activity as multiunit discharge (MSNA) and single units (s-MSNA).Results The s-MSNA in WHT (54 +/- 4.2 impulses/100 beats) was greater (p < 0.05) than in NT (37 +/- 5.4 impulses/100 beats) despite similar age and body mass index (BMI). The EHT values of s-MSNA (73 +/- 5.2 impulses/100 beats) were significantly (p < 0.05) greater than in WHT despite similar age, BMI and blood pressure levels. The MSNA followed a similar trend. White-coat hypertension had a similar cardiac baroreceptor reflex sensitivity to NT, but this was impaired in EHT relative to both NT and WHT.Conclusions It was shown, in the clinical setting, that central sympathetic hyperactivity exists in WHT, albeit to a lesser degree than EHT. These findings suggest that WHT may not be entirely benign and that the observed sympathetic hyperactivity may be responsible for development of target organ damage in this group of patients.

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  • Microneurographic studies almost universally show that sympathetic nerve traffic is potentiated in established hypertension in middle age and in elderly as well as young patients.

    “As far as the second issue is concerned, microneurographic studies almost universally shown that sympathetic nerve traffic is potentiated in established hypertension in middle age and in elderly as well as young patients38–46.”

    From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [41]

  • The sympathetic neural outflow is commonly activated also to the heart and skeletal muscle vasculature, but renal sympathetic activation is central to hypertension pathogenesis.

    “The sympathetic neural outflow is commonly activated also to the heart, shown with selective cardiac norepinephrine spillover measurements28, and to the skeletal muscle vasculature, demonstrated with microneurographic nerve traffic recording32,33,38–46, but it is the renal sympathetic activation which is central to hypertension pathogenesis96–97.”

    From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [41]

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Authors
Smith, P. A., Graham, L. N., Mackintosh, A. F., Stoker, J. B., & Mary, D. A. S. G.
Affiliations
Leeds Teaching Hospitals NHS Trust (GB)
Corresponding author
Smith, Paul A
ORCID
Mackintosh, Alan F
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2002-07
Volume
40
Issue
1
Pages
126-132
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/s0735-1097(02)01931-9
OpenAlex
W2052747904
Cited by
146
References
49
Citations by year
2026: 3 · 2025: 4 · 2024: 1 · 2023: 8 · 2022: 6 · 2021: 2 · 2020: 7 · 2019: 5 · 2018: 7 · 2017: 5 · 2016: 3 · 2015: 7 · 2014: 9 · 2013: 12 · 2012: 4
FWCI
3.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
Keywords
white coat hypertension, sympathetic hyperactivity, muscle sympathetic nerve activity, essential hypertension, baroreflex sensitivity, target organ damage, ambulatory blood pressure
MeSH terms
Adult, Blood Pressure, Female, Humans, Hypertension, Male, Middle Aged, Muscles, Pressoreceptors, Stress, Psychological, Sympathetic Nervous System, Vasoconstriction, Case-Control Studies

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