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Journal of Human Hypertension (2012) 26, 463475& 2012 Macmillan Publishers Limited All rights reserved 0950-9240/12
http://www.nature.com/jhh
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REVIEW
The sympathetic nervous system and blood pressure in humans: implications for hypertension
JP Fisher1 and JFR Paton2
1School of Sport and Exercise Sciences, College of Life & Environmental Sciences, University of Birmingham, Birmingham, UK and 2School of Physiology & Pharmacology, Bristol Heart Institute, Medical Sciences Building, University of Bristol, Bristol, UK
A neurogenic component to primary hypertension (hypertension) is now well established. Along with raised vasomotor tone and increased cardiac output, the chronic activation of the sympathetic nervous system in hypertension has a diverse range of patho-physiological consequences independent of any increase in blood pressure. This review provides a perspective on the actions and interactions of angiotensin II, inflammation and vascular dysfunction/brain
hypoperfusion in the pathogenesis and progression of neurogenic hypertension. The optimisation of current treatment strategies and the exciting recent developments in the therapeutic targeting of the sympathetic nervous system to control hypertension (for example, catheter-based renal denervation and carotid baroreceptor stimulation) will be outlined.
Journal of Human Hypertension (2012) 26, 463475; doi:http://dx.doi.org/10.1038/jhh.2011.66
Web End =10.1038/jhh.2011.66 ; published online 7 July 2011
Keywords: sympathetic nerve activity; neurogenic hypertension; immune-to-brain signalling
The sympathetic renaissance
Primary (or essential) hypertension (termed hyper-tension from here on) accounts for the vast majority of hypertensive cases (B95%).1 Although the aetiology of this condition is incompletely understood, it appears that along with genetic factors, several environmental and behavioural hypertensiogenic factors have been identified, such as obesity, insulin resistance, high-salt intake, low physical activity levels and stress.1 Given the elevated risk of stroke, renal failure, myocardial infarction and coronary heart disease in those afflicted with high blood pressure, the elucidation of the key pathogenic features and optimisation of effective therapeutic strategies are critical.
The most common form of hypertension is neurogenic hypertension, defined as high blood pressure with sympathetic overdrive, loss of parasympathetically mediated cardiac variability and excessive angiotensin II (Ang II) activity.2 The
importance of the sympathetic nervous system in the short-term regulation of blood pressure via the modulation of peripheral vascular tone and cardiac output is well established, while the role of the sympathetic nerve activity (SNA) in long-term blood pressure control is more controversial.35 Although the concept of...