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Sympathetic and Baroreflex Cardiovascular Control in Hypertension-Related Left Ventricular Dysfunction
Abstract
The sympathetic overdrive that characterizes essential hypertension is potentiated when left ventricular hypertrophy or congestive heart failure is detected. No information exists, however, on whether this is the case also for left ventricular diastolic dysfunction. In 17 untreated hypertensive subjects with left ventricular diastolic dysfunction (age: 47.7±2.9 years, mean±SEM), we measured sympathetic nerve traffic (microneurography), heart rate (ECG), and beat-to-beat arterial blood pressure (Finapres) at rest and during baroreceptor deactivation and stimulation. Data were compared with those collected in 20 age-matched normotensive and 20 hypertensive subjects without a diastolic function impairment. Muscle sympathetic nerve traffic values were markedly and significantly greater in the 2 hypertensive groups than in the normotensive one (55.3±1.2 and 71.2±1.6 versus 41.7±1.0 bursts per 100 heartbeats, respectively; P <0.01 for both). For a similar blood pressure elevation, however, the sympathetic nerve traffic increase was significantly greater in patients with than without left ventricular diastolic dysfunction (+28.9%; P <0.05). In the population as a whole, muscle sympathetic nerve traffic was significantly and inversely related to various echocardiographic indices of diastolic function. Although baroreflex-heart rate control was significantly attenuated in the 2 hypertensive groups, baroreflex-sympathetic modulation was impaired only in those with diastolic dysfunction. These data provide the first evidence that, in hypertension, activation of the sympathetic nervous system may contribute not only at the blood pressure elevation but also at the development of left ventricular diastolic dysfunction. The sympathetic overactivity, which is likely to be related to the baroreflex impairment, may account for the increased cardiovascular risk characterizing diastolic dysfunction.
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“Adrenergic neural factors may also contribute to the development and progression of target organ damage, as documented by the pronounced increase in sympathetic nerve traffic and cardiac norepinephrine spillover rate in patients in which hypertension is complicated by left ventricular hypertrophy or left ventricular diastolic dysfunction40,42,44,45.”
From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [45]
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“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 [45]
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2013 ESH/ESC Guidelines for the management of arterial hypertension
Authors Task Force Members, Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., Christiaens, T., Cífková, R., Backer, G. D., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht151 · Cited by 13,739
Self-citationRecommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography
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2007 Guidelines for the Management of Arterial Hypertension
Mancia, G., Backer, G. D., Dominiczak, A. F., Cífková, R., Fagard, R. H., Germanò, G., Grassi, G. M., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., et al. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e3281fc975a · Cited by 5,870
Self-citationEchocardiographic determination of left ventricular mass in man. Anatomic validation of the method.
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Baroreflex Control of Sympathetic Nerve Activity in Essential and Secondary Hypertension
Grassi, G., Cattaneo, B. M., Seravalle, G., Lanfranchi, A., & Mancia, G. (1998) · Hypertension · doi:10.1161/01.hyp.31.1.68 · Cited by 526
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The Sympathetic Nervous System in Heart Failure
Triposkiadis, F., Karayannis, G., Giamouzis, G., Skoularigis, J., Louridas, G., & Butler, J. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.05.015 · Cited by 978
The Autonomic Nervous System and Hypertension
Mancia, G., & Grassi, G. (2014) · Circulation Research · doi:10.1161/circresaha.114.302524 · Cited by 627
Self-citationThe Sympathetic Nervous System Alterations in Human Hypertension
Grassi, G., Mark, A., & Esler, M. (2015) · Circulation Research · doi:10.1161/circresaha.116.303604 · Cited by 616
Self-citationThe Autonomic Nervous System and Heart Failure
Florea, V. G., & Cohn, J. N. (2014) · Circulation Research · doi:10.1161/circresaha.114.302589 · Cited by 587
Hering, D., Lambert, E. A., Marusic, P., Walton, A. S., Krum, H., Lambert, G. W., Esler, M. D., & Schlaich, M. P. (2013) · Hypertension · doi:10.1161/hypertensionaha.111.00194 · Cited by 356
Metadata
- Authors
- Grassi, G., Seravalle, G., Quarti-Trevano, F., Dell'Oro, R., Arenare, F., Spaziani, D., & Mancia, G.
- Affiliations
- IRCCS Istituto Auxologico Italiano (IT)
- From the Clinica Medica (G.G., F.Q-T., R.D., F.A., G.M.), Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Milan, Italy; Istituto Auxologico Italiano (G.G., G.S., G.M.), Milan, Italy; and the Divisione di Cardiologia (D.S.), Ospedale di Legnano, Legnano, Italy.
- Venue
- Hypertension
- Published
- 2009-02
- Volume
- 53
- Issue
- 2
- Pages
- 205-209
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2122749049
- Cited by
- 194
- References
- 40
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 13 · 2023: 11 · 2022: 10 · 2021: 3 · 2020: 8 · 2019: 11 · 2018: 12 · 2017: 11 · 2016: 16 · 2015: 10 · 2014: 11 · 2013: 13 · 2012: 20
- FWCI
- 10.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- 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 › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- essential hypertension, left ventricular diastolic dysfunction, sympathetic nervous system, baroreflex, muscle sympathetic nerve activity, baroreflex sensitivity, rate control, cardiovascular risk, sympathetic hyperactivity
- MeSH terms
- Adult, Blood Pressure, Cardiac Output, Cardiovascular Physiological Phenomena, Heart Rate, Heart Ventricles, Humans, Hypertension, Male, Middle Aged, Stroke Volume, Sympathetic Nervous System, Echocardiography, Doppler, Case-Control Studies, Baroreflex, Ventricular Dysfunction, Left
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