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Cited by 99Heart Rate Variability and Autonomic ControlBlood Pressure and Hypertension StudiesCardiovascular Syncope and Autonomic Disorders

Sympathetic and reflex alterations in systo-diastolic and systolic hypertension of the elderly

Grassi, Guido, Seravalle, Gino, Bertinieri, Giovanni, Turri, Carlo, DellʼOro, Raffaella, Stella, Maria Luisa, Mancia, Giuseppe·2000·Journal of Hypertension
DOI 10.1097/00004872-200018050-00012
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Abstract

BACKGROUND: Previous studies have shown that young and middle-aged essential hypertensives are characterized by a sympathetic activation coupled with an impaired baroreflex-heart rate control. The present study aimed to determine whether these neuroadrenergic and reflex alterations also characterize systo-diastolic and systolic hypertension of the elderly. SUBJECTS AND METHODS: In 20 untreated elderly essential hypertensive subjects [10 with a systo-diastolic and 10 with an isolated systolic hypertension, aged 67.2 +/- 1.5 years and 66.9 +/- 1.7 years (mean +/- SEM)], we measured beat-to-beat arterial blood pressure (finger photoplethysmographic device), heart rate (electrocardiogram) and efferent postganglionic muscle sympathetic nerve activity (microneurography) at rest and during baroreceptor stimulation and deactivation induced by stepwise intravenous infusions of phenylephrine and nitroprusside, respectively. Data were compared with those obtained in 11 age-matched normotensive control subjects. RESULTS: Compared to the elderly normotensive group, muscle sympathetic nerve activity was increased to a similar degree in the group of systo-diastolic and systolic hypertension (50.8 +/- 4.2 versus 75.2 +/- 5.2 and 70.4 +/- 5.1 bursts per 100 heart beats, respectively, P< 0.01 for both). In the control group, the stepwise increase in arterial pressure induced by phenylephrine caused progressive bradycardia and sympathoinhibition, while the stepwise decrease in arterial pressure had opposite effects. While baroreceptor-heart rate control was markedly impaired (average reduction 41.6%), in both systo-diastolic and systolic hypertensive patients, baroreceptor modulation of sympathetic nerve traffic was similar to that seen in normotensive individuals. CONCLUSIONS: These data demonstrate that sympathetic activation is not only a feature of young and middle-aged, but also of elderly hypertensives, regardless of whether both systolic and diastolic or only systolic blood pressure is increased. They also show that hypertension of the elderly is not accompanied by an impaired baroreceptor modulation of sympathetic nerve traffic.

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Crossref · 10.1097/00004872-200018050-00012

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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 [39]

  • 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 skeletal muscle circulation.

    “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 [39]

  • 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 [39]

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Authors
Grassi, G., Seravalle, G., Bertinieri, G., Turri, C., DellʼOro, R., Stella, M. L., & Mancia, G.
Affiliations
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
Corresponding author
Mancia, Giuseppe
ORCID
Venue
Journal of Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2000
Volume
18
Issue
5
Pages
587-593
ISSN
0263-6352 (ISSN-L)
DOI
10.1097/00004872-200018050-00012
OpenAlex
W1973542881
Cited by
99
References
32
Citations by year
2026: 4 · 2023: 7 · 2022: 3 · 2019: 2 · 2018: 7 · 2017: 4 · 2016: 6 · 2015: 4 · 2014: 9 · 2013: 3 · 2012: 5
FWCI
3.21
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 › Surgery › Cardiovascular Syncope and Autonomic Disorders
Keywords
isolated systolic hypertension, sympathetic nervous system, muscle sympathetic nerve activity, baroreflex, phenylephrine, sodium nitroprusside, sympathoinhibition, autonomic dysfunction
MeSH terms
Adult, Aged, Aging, Blood Pressure, Diastole, Female, Humans, Hypertension, Male, Middle Aged, Nitroprusside, Phenylephrine, Pressoreceptors, Sympathetic Nervous System, Systole, Case-Control Studies, Baroreflex

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