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How to assess sympathetic activity in humans
Abstract
Sympathetic factors play a central role not only in cardiovascular homeostatic control but also in the pathogenesis and/or in the progression of several cardiovascular diseases, such as essential hypertension, myocardial infarction, cardiac arrhythmias and congestive heart failure. This explains why assessment of adrenergic neural function in humans has been, and certainly still remains, one of the major fields in cardiovascular research. The present paper will review in detail the haemodynamic, pharmacological, biochemical, neurophysiological, neurochemical and neural imaging techniques by which sympathetic activity is assessed in humans, highlighting the main advantages and limitations of each of them. Although plasma noradrenaline measurement represents a useful guide to assess sympathetic neural function, direct recording of sympathetic nerve traffic via microneurography and noradrenaline radiotracer methods have in recent years largely supplanted the plasma noradrenaline approach. This is because they allow (1) discrimination between the central or peripheral nature of increased plasma noradrenaline levels, and (2) precise estimation of the behaviour of regional sympathetic neural function both under physiological and pathological conditions. In contrast, the approach based on spectral analysis of heart rate and blood pressure signals has been shown to have important limitations which prevent the method from faithfully reflecting sympathetic cardiovascular drive. Neural imaging techniques, which require expensive technical support, allow direct visualization of sympathetic enervation of human organs, thus providing information on the 'in vivo' metabolism of noradrenaline in different cardiovascular districts. Although technical improvements have allowed a more precise assessment of human adrenergic function, no technique so far available can be viewed as a 'gold standard' with which the others might be compared. Limitations and disadvantages of the various techniques may be reduced if these methods are seen as being complementary and employed in combination, allowing more reliable information to be achieved on the sympathetic abnormalities characterizing cardiovascular diseases, and thus hopefully providing a stronger rationale for newer therapeutic approaches involving pharmacological modification of the sympathetic nervous system and adrenoreceptors.
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“In healthy humans there are good relationships between the microneurographic data collected in the peroneal nerve and the ones characterizing the cardiac or the renal neural network, but this may not pertain in pathologic states22,.”
From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [22]
In the citing paper
“As a result of these complexities, there is no such thing as “overall” or “generalized” sympathetic nerve activity or tone, and one cannot obtain an overall assessment of the sympathetic nervous system with any single method.”
From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [22]
In the citing paper
“However, the sensitivity and reproducibility of the measurements are far from optimal22.”
From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [22]
In the citing paper
“Interestingly, studies of elderly hypertensives have not always documented an increase in renal norepinephrine spillover in contrast to the finding of increased sympathetic nerve traffic to the skeletal muscle circulation22,28,39,47.”
From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [22]
In the citing paper
“This possibility can be definitively excluded, however, because the pattern of sympathetic activation in lean hypertensive patients differs materially from that seen in mental stress responses.”
From Phenotypic Evidence of Faulty Neuronal Norepinephrine Reuptake in Essential Hypertension (2000) · cites this paper as [18]
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Seravalle, G., Brambilla, G., Pizzala, D. P., & Grassi, G. M. (2018) · Updates in hypertension and cardiovascular protection · doi:10.1007/978-3-319-59918-2_6 · Cited by 1
Self-citationGronda, E., & Vanoli, E. (2020) · Springer eBooks · doi:10.1007/978-3-030-28008-6_3 · Cited by 1
Sympathetic vascular tone in human obesity
Correia, M. (2007) · doi:10.17077/etd.v54kf0if · Cited by 1
Assessment of 24-h neuroadrenergic profile: does the dream come true?
Grassi, G. M. (2005) · Journal of Hypertension · doi:10.1097/01.hjh.0000170375.15838.e3 · Cited by 1
Self-citationSympathetic Drive as a Determinant of Weight Loss Intervention OutcomeStrengths and Limitations
Grassi, G. M. (2005) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2005.06.021 · Cited by 1
Self-citationGrassi, G. M. (2013) · Journal of Hypertension · doi:10.1097/hjh.0b013e32836541ae · Cited by 1
Self-citationGrassi, G. M. (2007) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1002134 · Cited by 1
Self-citationBallentine, H. M. (2001) · VTechWorks (Virginia Tech) · Cited by 1
Tuuri, A. (2014) · Työväentutkimus Vuosikirja · Cited by 1
Association between autonomic regulation and cardiovascular risk factors in middle-aged subjects
Virtanen, R. (2007) · STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) · Cited by 1
Clinical Studies of the Sympathetic Nervous System
Rumantir, M., & Esler, M. (2002) · CRC Press eBooks · doi:10.1201/9780203908891-12 · Cited by 1
Self-citationCardiac Sympathetic Neuroimaging
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The Function of the Autonomic Nervous System in Hypertension
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Omega-3 fatty acids and the neurovascular responses to mental stress in humans
Schwartz, C. E. (2011) · Digital Commons - Michigan Tech (Michigan Technological University) · doi:10.37099/mtu.dc.etds/194
Metadata
- Authors
- Grassi, G., & Esler, M.
- Affiliations
- University of Milan (IT)
- Corresponding author
- Grassi, Guido
- Venue
- Journal of Hypertension
- Published
- 1999-06
- Volume
- 17
- Issue
- 6
- Pages
- 719-734
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2091732895
- Semantic Scholar
- bc74577c141bc3ba2446fc838afe6f049c0c2e1d
- Cited by
- 455
- References
- 137
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 9 · 2023: 12 · 2022: 7 · 2021: 9 · 2020: 16 · 2019: 22 · 2018: 12 · 2017: 11 · 2016: 22 · 2015: 21 · 2014: 19 · 2013: 17 · 2012: 23
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Keywords
- sympathetic nervous system, plasma norepinephrine, microneurography, heart rate variability, blood pressure variability, spectral analysis, cardiovascular disease, essential hypertension, congestive heart failure, adrenergic receptors
- MeSH terms
- Cardiovascular System, Hemodynamics, Humans, Norepinephrine, Sympathetic Nervous System, Tomography, Emission-Computed
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