The human sympathetic nervous system: its relevance in hypertension and heart failure
Open accessAbstract
Evidence assembled in this review indicates that sympathetic nervous system dysfunction is crucial in the development of heart failure and essential hypertension. This takes the form of persistent and adverse activation of sympathetic outflows to the heart and kidneys in both conditions. An important goal for clinical scientists is translation of the knowledge of pathophysiology, such as this, into better treatment for patients. The achievement of this 'mechanisms to management' transition is at different stages of development with regard to the two disorders. Clinical translation is mature in cardiac failure, knowledge of cardiac neural pathophysiology having led to the introduction of beta-adrenergic blockers, an effective therapy. With essential hypertension perhaps we are on the cusp of effective translation, with recent successful testing of selective catheter-based renal sympathetic nerve ablation in patients with resistant hypertension, an intervention firmly based on the demonstration of activation of the renal sympathetic outflow. Additional evidence in this regard is provided by the results of pilot studies exploring the possibility to reduce blood pressure in resistant hypertensives through electrical stimulation of the area of carotid baroreceptors. Despite the general importance of the sympathetic nervous system in blood pressure regulation, and the specific demonstration that the blood pressure elevation in essential hypertension is commonly initiated and sustained by sympathetic nervous activation, drugs antagonizing this system are currently underutilized in the care of patients with hypertension. Use of beta-adrenergic blocking drugs is waning, given the propensity of this drug class to have adverse metabolic effects, including predisposition to diabetes development. The blood pressure lowering achieved with carotid baroreceptor stimulation and with the renal denervation device affirms the importance of the sympathetic nervous system in hypertension pathogenesis, and perhaps suggests a wider role for anti-adrenergic antihypertensives, such as the imidazoline drug class (moxonidine, rilmenidine) which act within the CNS to inhibit central sympathetic outflow, although the lack of large-scale outcome trials with this drug class remains a very material deficiency.
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Human sympathetic nervous system dysfunction plays an important role in the development and progression of hypertension, heart failure, and CKD.
“Human sympathetic nervous system dysfunction plays an important role in the development and progression of hypertension, heart failure, and CKD.398,399”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [398]
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Carmichael, C. Y., & Wainford, R. D. (2015) · Current Hypertension Reports · doi:10.1007/s11906-015-0550-4 · Cited by 78 · see citing works
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- Authors
- Parati, G., & Esler, M.
- Affiliations
- IRCCS Istituto Auxologico Italiano (IT)
- Baker Heart and Diabetes Institute (AU)
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-04-16
- Volume
- 33
- Issue
- 9
- Pages
- 1058-1066
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2148841524
- Cited by
- 538
- References
- 84
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 19 · 2023: 74 · 2022: 22 · 2021: 19 · 2020: 30 · 2019: 26 · 2018: 35 · 2017: 35 · 2016: 49 · 2015: 53 · 2014: 65 · 2013: 74 · 2012: 9
- FWCI
- 10.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- 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
- sympathetic nervous system, essential hypertension, heart failure, resistant hypertension, beta-blockers, carotid baroreceptor stimulation, blood pressure regulation, central sympathetic outflow, diabetes risk
- MeSH terms
- Adrenergic beta-Antagonists, Arrhythmias, Cardiac, Autonomic Nervous System Diseases, Blood Pressure, Electric Stimulation Therapy, Equipment Design, Heart Failure, Humans, Hypertension, Insulin Resistance, Kidney Failure, Chronic, Myocardium, Norepinephrine, Receptors, Adrenergic, beta, Catheter Ablation, Hypertrophy, Left Ventricular, Baroreflex, Prostheses and Implants, Sleep Apnea, Obstructive
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