Advances in the role of the Sympathetic Nervous System in cardiovascular medicine
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The autonomic nervous system in arterial hypertension: what is new?

Elghozi JL, Herpin O.



Summary

Recent publications concerning the role of the autonomic nervous system in hypertension have demonstrated the nature of spontaneous oscillations of the blood pressure. The contribution of sympathetic stimulations indicates the baroreflex nature of certain rhythms, which opens a perspective of understanding the relationship between increased sympathetic activity and hypertension. The sympathetic nervous system, angiotensin II, and aldosterone are related, and antihypertensive therapy may therefore target one or the other, providing that the regulating functions are maintained. These concepts are developed in a recent series of articles which are presented schematically in this update.

Arch Mal Cœur Vaiss. 2000;93:1381-1386.


Commentary

The present review paper addresses a series of new findings and techniques in connection with the role of the autonomic nervous system in hypertensive disease. The authors pay particular attention to the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the interactions between these two major pathophysiological entities.We mention here a few relevant examples.

1. An elegant technique is described which has been used to demonstrate in chicken eggs the influence of age on hemodynamic parameters in ovo.

2. A noradrenaline transporter system has been identified biochemically and functionally.This system plays a role in the release of noradrenaline from the sympathetic nerve endings.

3.The genetic background of the baroreceptor system has been identified.

4. Spontaneous oscillation waves in SNS activity and blood pressure (so-called Mayer waves, with a low frequency) have been studied in detail.The involvement of various systems and parameters, such as EDRF/NO, the RAAS, SNS activity, and heart rate are discussed.

5. A brief survey was done of the relationship between SNS and hypertensive disease, including the issue of dippers/nondippers, which is believed to involve changes in SNS activity.

6. Finally, advice was given with respect to drug treatment, ie, that it would be preferable to subject SNS hyperactivity to subtle modification rather than to bluntly block it.

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