Sympathetic modulation as a goal of antihypertensive treatment: from drugs to devices

Abstract

The present study aims to examine the effects of nonpharmacological, pharmacological and devices-based treatment on hypertension-related sympathetic overactivity. This will be done by analyzing the results of different published studies, in which sympathetic activity has been assessed via indirect or direct techniques. After examining the rationale for sympathomodulatory interventions in antihypertensive treatment, the study will discuss the methodological intrinsic limitations of the studies aimed at assessing different therapeutic interventions. The core of the study will be then focused on the effects of nonpharmacological (dietary restriction of sodium intake, physical exercise training, weight reduction), pharmacological (monotherapy, combination drug treatment, new drugs such as sodium glucose co-transport protein-2 inhibitors and angiotensin receptor neprilysin inhibitors), as well as devices-based interventions (renal sympathetic nerves ablation and carotid baroreceptor activation therapy) on the hypertension-related sympathetic overdrive. Finally, the areas worthy of future research as well as the debated issues in the field will be highlighted.

Baroreceptors as a target of device‐based neuromodulation in heart failure: Long‐term outcomes

“…Mention should also be made on the fact that a similar phenomenon has been described in treated hypertensive patients, who, despite effective antihypertensive drug treatment, display a risk of cardiovascular events greater for magnitude than the one characterizing pure normotensive healthy individuals 14 . Also in this case, however, the working hypothesis has been advanced that pharmacological treatment might be unable to fully normalize the sympathetic overactivity and the baroreflex dysfunction of the treated hypertensive patients and to fully reverse the cardiovascular structural and/or functional alterations characterizing the high blood pressure state 15 …”

“…14 Also in this case, however, the working hypothesis has been advanced that pharmacological treatment might be unable to fully normalize the sympathetic overactivity and the baroreflex dysfunction of the treated hypertensive patients and to fully reverse the cardiovascular structural and/or functional alterations characterizing the high blood pressure state. 15 In summary, the study by Zile and co-workers 5 represents an appreciable update of the clinical effects of the BAT procedure in heart failure, allowing to better define the common 'lights and shadows' of the device-based approach.…”