Elevated sympathetic nerve activity in patients with accelerated essential hypertension.

Matsukawa, Tetsuya; Mano, Tadaaki; Gotoh, Eiji; Ishii, Masao

doi:10.1172/jci116558

Cited by 86 publications

(27 citation statements)

References 19 publications

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“…5 This may operate through the adoption of less healthy lifestyles and general neglect of health by the patients, or through the stimulation of the sympathetic nervous system. Elevated sympathetic nerve activity has been found in accelerated hypertension, 16 and may act by stimulating renin release, increasing vasomotor tone and vascular permeability, and promoting the proliferation of vascular cells. 17 However, the inability to implicate stress per se in the aetiopathogenesis of hypertension 12 and our use of a reporting of perceived stress rather than a structured questionnaire might reduce the strength of the association between stress and MHT found in this study.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the development of malignant hypertension in Nigeria

2000

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Hypertension prevalence rates remain comparatively low in Nigeria, although the associated morbidity and mortality including that due to malignant hypertension (MHT) is considerable. To determine the factors that may be associated with the development of MHT we compared 74 patients with essential MHT (age 48 ؎ 9 years, 59 male, blood pressure (BP) 234 ؎ 31/140 ؎ 17 mm Hg) with 74, age, gender and BP-matched patients with essential benign hypertension (BHT) (49 ؎ 8 years, 60 male, 227 ؎ 26/136 ؎ 15 mm Hg). Body mass index was higher in the MHT group by 1.3 (95% Cl: 0.5 to 2.1, P Ͻ 0.01). In the subset (25 MHT, 43 BHT) in whom hypertension had been diagnosed before presentation, duration of hypertension was shorter (P Ͻ 0.05) in the Keywords: malignant hypertension; risk factors; black Nigerians IntroductionMalignant hypertension (MHT) remains a common condition in some populations, 1,2 and although its prognosis may be improving, it is still associated with considerable morbidity.1 Very high blood pressure (BP) is required for the development of MHT, but since the BP alone does not distinguish non-malignant, benign hypertension (BHT) from MHT and both conditions may exist at similar BP, other factors are clearly in operation.3-5 Some of these may relate to the kidney or vasculature, 3 the immune system 4 and to external or environmental differences.5 It may be possible to manipulate these external variables and prevent the transition to the malignant phase. Prevention of the transition to the malignant phase would reduce the morbidity and mortality attributable to hypertension, since the prognosis is worse in MHT. 6,7 This study aims at identifying these external factors in black Nigerian hypertensives, a group that is arguably underserved. Patients and methodsA record has been kept of the cases of MHT seen in over 10 years. MHT was diagnosed on the basis of severe hypertension with bilateral retinal exudates and haemorrhages with or without papilloedema. 8,9 A detailed account of the clinical presentation of some of the patients has been published elsewhere. 10Patients with secondary causes of hypertension were excluded. Secondary hypertension was excluded on the basis of history, physical examination, urine examination, serum electrolytes, renal ultrasound and renal arteriography as presented in the earlier study. 10 The presence of primary renal disease was suggested by the presence of urinary red cells, red and white cell casts, granular casts and proteinuria up to 1.5 g/24 h. 11 Where there was some doubt as to the cause of the hypertension, such patients were excluded. Accordingly, 74 patients were considered to have primary MHT. These patients were compared with 74 age, gender and BPmatched controls with benign essential hypertension newly presenting at the hypertension clinic. They necessarily had repeatedly high BP readings and grade 3 hypertension. 12Age, gender, body mass index (BMI), socio-economic group, BP, serum creatinine, history of smoking and alcohol use, perception of stress, known duration o...

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Section: Discussionmentioning

confidence: 99%

Factors influencing the development of malignant hypertension in Nigeria

2000

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“…In patients with hypertension, MSNA has been reported to be higher than [5][6][7] or similar to 8 -10 measurements in normotensive control subjects. Studies in normal subjects have reported that MSNA is linked to heart rate (HR) 11 but is unrelated to blood pressure.…”

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confidence: 57%

Interactive Effect of Heart Rate and Muscle Sympathetic Nerve Activity on Blood Pressure

Narkiewicz

Somers

1999

Circulation

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Background-Sympathetic traffic to the peripheral vasculature and sympathetic discharge to the heart have complementary effects on blood pressure. Although faster heart rates have been linked to higher blood pressures, the relationship between muscle sympathetic nerve activity (MSNA) and long-term regulation of blood pressure is not clear. We tested the hypothesis that MSNA and heart rate are linked to blood pressure levels in normotensive subjects. Methods and Results-We studied normal young male (nϭ120) and female (nϭ48) subjects subdivided according to tertiles of heart rate and MSNA distributions. Systolic, diastolic, and pulse pressures were significantly different across the heart rate tertiles in male subjects, with the highest blood pressure values in the upper tertile of heart rate. No significant differences in blood pressure across the tertiles of MSNA were found. The relationship between MSNA and blood pressure, however, was affected by heart rate. MSNA did not influence blood pressure in the first and second heart rate tertiles. However, within the upper heart rate tertile, subjects with higher levels of MSNA had significantly higher systolic (Pϭ0.02) and pulse (Pϭ0.004) pressures than subjects with lower levels of MSNA. In female subjects, blood pressure was not different across the tertiles of heart rate or MSNA. Conclusions-MSNA and heart rate have interactive effects on systolic blood pressure and pulse pressure in normotensive male but not female subjects. No relationship between MSNA and blood pressure or pulse pressure is evident in subjects with slower heart rate. In male subjects with faster heart rates, higher levels of MSNA are associated with higher systolic and pulse pressures. (Circulation. 1999;100:2514-2518.)

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“…Hypertension blunts baroreflex sensitivity (BRS) and vascular compliance [29,30] , and therefore may lead to the occurrence of OH. In contrast, OHT may be related to the [31,32] . Excessive venous pooling in the lower extremities upon standing can lead to a decrease in cardiac output, which may result in vigorous activation of the sympathetic nervous system and excessive arteriolar vasoconstriction in hypertensives with sympathetic hyperactivity, thus causing OHT.…”

Section: Discussionmentioning

confidence: 93%

Polymorphisms of angiotensin-converting enzyme (ACE) and ACE2 are not associated with orthostatic blood pressure dysregulation in hypertensive patients

Fan

Wang

et al. 2009

Acta Pharmacol Sin

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Aim: The genetic background of orthostatic blood pressure dysregulation remains poorly understood. Since the renin-angiotensin system plays an important role in blood pressure regulation and response to position change, we hypothesized that angiotensin-converting enzyme (ACE) and ACE2 genetic polymorphisms might contribute, at least partially, to orthostatic blood pressure dysregulation in hypertensive patients. Methods: Two tag single nucleotide polymorphisms (SNPs) of ACE2 and ACE I/D were genotyped in 3630 untreated hypertensive patients and 826 normotensive subjects. Orthostatic hypertension was defined as an increase in systolic blood pressure of 20 mmHg or more and orthostatic hypotension as a drop in blood pressure of 20/10 mmHg or more within three minutes of assumption of upright posture. Results: Female and male patients had similar rates of orthostatic hypertension (16.5% vs 15.3%) and hypotension (22.5% vs 23.8%). No significant differences were detected in the minor allele frequency of ACE2 rs2106809, rs2285666, or ACE I/D in either female or male patients with orthostatic hypertension (15.1%, 22.7%, 19.6%, respectively), hypotension (13.8%, 25%, 16.5%), or normal orthostatic blood pressure response (14.4%, 21.9%, 15.8%) in additive, dominant or recessive models after adjustment for confounders (all P>0.05). The orthostatic changes in systolic and diastolic blood pressure were also comparable among patients carrying different genotypes. Similar results were observed in normotensive subjects. Conclusion: These data provide no support for the involvement of ACE or ACE2 in the genetic predisposition to orthostatic hypotension or hypertension.

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Elevated sympathetic nerve activity in patients with accelerated essential hypertension.

Cited by 86 publications

References 19 publications

Factors influencing the development of malignant hypertension in Nigeria

Factors influencing the development of malignant hypertension in Nigeria

Interactive Effect of Heart Rate and Muscle Sympathetic Nerve Activity on Blood Pressure

Polymorphisms of angiotensin-converting enzyme (ACE) and ACE2 are not associated with orthostatic blood pressure dysregulation in hypertensive patients

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