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Cardiology Clinics Feb 2015Resistant hypertension affects 20% to 30% of patients with high blood pressure (BP). It is defined as failure to achieve goal BP despite using at least 3... (Review)
Review
Resistant hypertension affects 20% to 30% of patients with high blood pressure (BP). It is defined as failure to achieve goal BP despite using at least 3 antihypertensive drugs of different classes, at maximal tolerated doses, one of which must be a diuretic. Persistent suboptimal BP is the most common attributable risk for death worldwide and its prevalence will most likely increase over the next decade. We review the epidemiologic aspects and diagnostic challenges of resistant hypertension, barriers to achieving proper BP control, and causes of secondary hypertension. Lifestyle modification and pharmacologic and device approaches to treatment are discussed.
Topics: Aged; Antihypertensive Agents; Cooperative Behavior; Coronary Vasospasm; Cross-Sectional Studies; Diuretics; Dose-Response Relationship, Drug; Drug Therapy, Combination; Electric Stimulation Therapy; Female; Humans; Hypertension; Interdisciplinary Communication; Kidney; Life Style; Male; Medication Adherence; Middle Aged; Pressoreceptors; Prognosis; Sympathectomy
PubMed: 25439332
DOI: 10.1016/j.ccl.2014.09.003 -
Current Hypertension Reports Mar 2015Heart failure has emerged as one of the most important diseases of the past century. The understanding and treatment of heart failure has evolved significantly over the... (Review)
Review
Heart failure has emerged as one of the most important diseases of the past century. The understanding and treatment of heart failure has evolved significantly over the years. As we move further into the era of device therapy, attention has turned to the idea of sympathetic nervous system modulation through renal denervation to treat heart failure. In this review, we summarize the background research, denervation technique, and current studies on renal denervation for the treatment of heart failure. We also compare and contrast the work on carotid barostimulation.
Topics: Animals; Denervation; Heart Failure; Humans; Kidney; Pressoreceptors; Sympathectomy; Sympathetic Nervous System
PubMed: 25754320
DOI: 10.1007/s11906-014-0528-7 -
Transfusion Clinique Et Biologique :... Nov 2016This review addresses the pathophysiology of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume, which may lead to hemodynamic... (Review)
Review
This review addresses the pathophysiology of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume, which may lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. The initial neuroendocrine response is mainly a sympathetic activation. Haemorrhagic shock is associated altered microcirculatory permeability and visceral injury. It is also responsible for a complex inflammatory response associated with hemostasis alteration.
Topics: Adaptation, Physiological; Animals; Blood Volume; Chemoreceptor Cells; Disseminated Intravascular Coagulation; Hemodynamics; Humans; Hypotension; Hypoxia; Inflammation; Microcirculation; Models, Animal; Oxygen; Pressoreceptors; Shock, Hemorrhagic; Sympathetic Nervous System; Vasoconstriction
PubMed: 27567990
DOI: 10.1016/j.tracli.2016.07.004 -
Expert Review of Medical Devices Dec 2019: Resistant hypertension is characterized by an hyperadrenergic tone and by a neurohumoral activation. In this condition drug therapies are unable to obtain a good... (Review)
Review
: Resistant hypertension is characterized by an hyperadrenergic tone and by a neurohumoral activation. In this condition drug therapies are unable to obtain a good control of blood pressure and therefore need a contribution from non-pharmachological approach. To this aim it has been hypothesized that to lower blood pressure this could be obtained through stimulation of carotid baroreceptors and modulation of the adrenergic tone.: several studies and trials have evaluated the safety and efficacy of two devices-based therapies and this review will discuss the research obtained mainly in resistant hypertensive subjects.: the studies performed have clearly shown the safety and efficacy of these approaches. The stimulation of carotid baroreceptors induces a significant reduction in blood pressure values associated with a reduction in adrenergic tone. The two systems have same limitations. While baroreflex activation therapy has been upgraded to a more simple system, an upgrade of endovascular baroreflex amplification will be able to reduce the side effects. Due to the fact that neurohumoral activation and hyperadrenergic tone are present in several pathophysiological conditions it is possible to assume a wider use of these systems in the future.
Topics: Baroreflex; Electric Stimulation Therapy; Humans; Hypertension; Pressoreceptors; Sympathetic Nervous System
PubMed: 31774336
DOI: 10.1080/17434440.2019.1697230 -
Current Hypertension Reports Sep 2018To review the role and evidence for sympathetic overactivity in resistant hypertension and review the therapies that have been studied to modulate the sympathetic... (Review)
Review
PURPOSE OF REVIEW
To review the role and evidence for sympathetic overactivity in resistant hypertension and review the therapies that have been studied to modulate the sympathetic nervous system to treat resistant hypertension, with a focus on non-pharmacologic therapies such as renal denervation, baroreflex activation therapy, and carotid body ablation.
RECENT FINDINGS
Based on the two best current techniques available for assessing sympathetic nerve activity, resistant hypertension is characterized by increased sympathetic nerve activity. Several device therapies, including renal denervation baroreflex activation therapy and carotid body ablation, have been developed as non-pharmacologic means of reducing blood pressure in resistant hypertension. With respect to renal denervation, the technologies for renal denervation have evolved since the unfavorable results from the HTN-3 study, and the revised technologies are being actively studied. Data from the first phase of the SPYRAL HTN Clinical Trial Program have been published. Results from the SPYRAL HTN-OFF MED trial suggest that ablating renal nerves can reduce blood pressure in patients with untreated mild-to-moderate hypertension. The SPYRAL HTN-ON MED trial demonstrated the safety and efficacy of catheter-based renal denervation in patients with uncontrolled hypertension on antihypertensive treatment. Interestingly, there was a high rate of medication non-adherence among patients with hypertension in this study. One attractive alternative to radiofrequency ablation is the use of ultrasound for renal denervation. Proof of concept data for the Paradise endovascular ultrasound renal denervation system was recently published in the RADIANCE-HTN SOLO trial. The results of this trial indicate that, among patients with mild to moderate hypertension on no medications, renal denervation with the Paradise system results in a greater reduction in both SBP and DBP at 2months compared with a sham procedure. Overall reductions were similar in magnitude to those noted in the SPYRAL HTN-OFF MED study. With respect to carotid body ablation, there is an ongoing proof of concept study that is investigating the safety and feasibility of ultrasound-based endovascular carotid body ablation in 30 subjects with treatment-resistant hypertension outside of the USA. The sympathetic nervous system is an important contributor to resistant hypertension. Modulation of sympathetic overactivity should be an important goal of treatment. Innovative therapies using non-pharmacologic means to suppress the sympathetic nervous system are actively being studied to treat resistant hypertension.
Topics: Antihypertensive Agents; Baroreflex; Carotid Body; Clinical Trials as Topic; Drug Resistance; Electrodes, Implanted; Humans; Hypertension; Kidney; Pressoreceptors; Radiofrequency Ablation; Sympathectomy; Sympathetic Nervous System
PubMed: 30194545
DOI: 10.1007/s11906-018-0893-8 -
Advances in Physiology Education Jun 2022While the effects of changing heart rate and systemic vascular resistance have been generally understood and appreciated, the effects of changes in left ventricular... (Review)
Review
While the effects of changing heart rate and systemic vascular resistance have been generally understood and appreciated, the effects of changes in left ventricular contractility on end-systolic volume may have been less understood and appreciated and the effects of changes in venous capacitance on end-diastolic volume may have been unknown to many readers. Herein, we have provided a brief review for the medical student and beginning graduate student highlighting these sometimes-complex relationships.
Topics: Blood Pressure; Heart Rate; Heart Ventricles; Humans; Pressoreceptors; Vascular Resistance
PubMed: 35201919
DOI: 10.1152/advan.00160.2021 -
Current Hypertension Reports May 2017Dietary salt intake increases both plasma sodium and osmolality and therefore increases vasopressin (VP) release from the neurohypophysis. Although this effect could... (Review)
Review
PURPOSE OF REVIEW
Dietary salt intake increases both plasma sodium and osmolality and therefore increases vasopressin (VP) release from the neurohypophysis. Although this effect could increase blood pressure by inducing fluid reabsorption and vasoconstriction, acute activation of arterial baroreceptors inhibits VP neurons via GABA receptors to oppose high blood pressure. Here we review recent findings demonstrating that this protective mechanism fails during chronic high salt intake in rats.
RECENT FINDINGS
Two recent studies showed that chronic high sodium intake causes an increase in intracellular chloride concentration in VP neurons. This effect causes GABA receptors to become excitatory and leads to the emergence of VP-dependent hypertension. One study showed that the increase in intracellular chloride was provoked by a decrease in the expression of the chloride exporter KCC2 mediated by local secretion of brain-derived neurotrophic factor and activation of TrkB receptors. Prolonged high dietary salt intake can cause pathological plasticity in a central homeostatic circuit that controls VP secretion and thereby contribute to peripheral vasoconstriction and hypertension.
Topics: Animals; Blood Pressure; Humans; Hypertension; Male; Osmolar Concentration; Pressoreceptors; Rats; Sodium Chloride; Sodium Chloride, Dietary; Vasopressins
PubMed: 28451854
DOI: 10.1007/s11906-017-0741-2 -
Current Aging Science Aug 2022This review outlines the normal heart rate and blood pressure response to active standing, the physiological mechanisms governing these, and the effect of ageing on the... (Review)
Review
OBJECTIVES
This review outlines the normal heart rate and blood pressure response to active standing, the physiological mechanisms governing these, and the effect of ageing on the responses.
METHODS
A literature search was conducted to identify articles investigating the normal heart rate and/or blood pressure response to standing.
RESULTS
Heart rate when standing increases and then decreases and recovers to baseline. Blood pressure responses are inverse. Skeletal muscle contraction and the baroreceptor reflex drive this. With ageing, heart rate response attenuates and the initial blood pressure response increases.
DISCUSSION
Normal heart rate and blood pressure responses are attributed to the baroreceptor reflex and skeletal muscle contraction. Decreased muscle strength and baroreceptor sensitivity are associated with ageing, suggesting a possible benefit in improving skeletal muscle strength to maintain an efficient response. Understanding these responses and their variation with ageing is clinically relevant and may be beneficial in improving rehabilitation outcomes.
Topics: Baroreflex; Blood Pressure; Heart Rate; Humans; Muscle Contraction; Pressoreceptors
PubMed: 35440341
DOI: 10.2174/1874609815666220419102648 -
Pharmacological Research Feb 2021Baroreflex plays a crucial role in regulation of arterial blood pressure (BP). Recently, Piezo1 and Piezo2, the mechanically-activated (MA) ion channels, have been...
Baroreflex plays a crucial role in regulation of arterial blood pressure (BP). Recently, Piezo1 and Piezo2, the mechanically-activated (MA) ion channels, have been identified as baroreceptors. However, the underlying molecular mechanism for regulating these baroreceptors in hypertension remains unknown. In this study, we used spontaneously hypertensive rats (SHR) and NG-Nitro-l-Arginine (L-NNA)- and Angiotensin II (Ang II)-induced hypertensive model rats to determine the role and mechanism of Piezo1 and Piezo2 in hypertension. We found that Piezo2 was dominantly expressed in baroreceptor nodose ganglia (NG) neurons and aortic nerve endings in Wistar-Kyoto (WKY) rats. The expression of Piezo2 not Piezo1 was significantly downregulated in these regions in SHR and hypertensive model rats. Electrophysiological results showed that the rapidly adapting mechanically-activated (RA-MA) currents and the responsive neuron numbers were significantly reduced in baroreceptor NG neurons in SHR. In WKY rats, the arterial BP was elevated by knocking down the expression of Piezo2 or inhibiting MA channel activity by GsMTx4 in NG. Knockdown of Piezo2 in NG also attenuated the baroreflex and increased serum norepinephrine (NE) concentration in WKY rats. Co-immunoprecipitation experiment suggested that Piezo2 interacted with Neural precursor cell-expressed developmentally downregulated gene 4 type 2 (Nedd4-2, also known as Nedd4L); Electrophysiological results showed that Nedd4-2 inhibited Piezo2 MA currents in co-expressed HEK293T cells. Additionally, Nedd4-2 was upregulated in NG baroreceptor neurons in SHR. Collectively, our results demonstrate that Piezo2 not Piezo1 may act as baroreceptor to regulate arterial BP in rats. Nedd4-2 induced downregulation of Piezo2 in baroreceptor NG neurons leads to hypertension in rats. Our findings provide a novel insight into the molecular mechanism for the regulation of baroreceptor Piezo2 and its critical role in the pathogenesis of hypertension.
Topics: Animals; Aorta, Thoracic; Baroreflex; Cells, Cultured; Humans; Hypertension; Ion Channels; Male; Nedd4 Ubiquitin Protein Ligases; Neurons; Nodose Ganglion; Pressoreceptors; Rats, Inbred SHR; Rats, Inbred WKY; Signal Transduction; Rats
PubMed: 33352230
DOI: 10.1016/j.phrs.2020.105391 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Nov 2021With the continuous updating of head and neck surgery concepts and techniques, more and more head and neck surgeries are developing in the direction of... (Review)
Review
With the continuous updating of head and neck surgery concepts and techniques, more and more head and neck surgeries are developing in the direction of refinement.however, the more complete the surgery, the greater the possibility of subsequent nerve exposure and injury. Even a slight perturbation of the nerve may cause serious complications, such as pressure receptor failure.It is necessary to review the mechanisms and the characteristics of baroreceptor failure syndrome after head and neck tumor surgery.
Topics: Head; Head and Neck Neoplasms; Humans; Neck; Postoperative Complications; Pressoreceptors
PubMed: 34886615
DOI: 10.13201/j.issn.2096-7993.2021.11.020