Sympathetic Nerve Activity and Blood Pressure Response to Exercise in Peripheral Artery Disease: From Molecular Mechanisms, Human Studies, to Intervention Strategy Development

Abstract

Sympathetic nerve activity (SNA) regulates the contraction of vascular smooth muscle and leads to a change in arterial blood pressure (BP). It was observed that SNA, vascular contractility, and BP are heightened in patients with peripheral artery disease (PAD) during exercise. The exercise pressor reflex (EPR), a neural mechanism responsible for BP response to activation of muscle afferent nerve, is a determinant of the exaggerated exercise-induced BP rise in PAD. Based on recent results obtained from a series of studies in PAD patients and a rat model of PAD, this review will shed light on SNA-driven BP response and the underlying mechanisms by which receptors and molecular mediators in muscle afferent nerves mediate the abnormalities in autonomic activities of PAD. Intervention strategies, particularly non-pharmacological strategies, improving the deleterious exercise-induced SNA and BP in PAD, and enhancing tolerance and performance during exercise will also be discussed.

Transition in human heart rate variability indices due to spread of the COVID-19: Comparison of young and elderly groups by ALLSTAR big data analysis

“…On the other hand, the parasympathetic nerves, which are centered in the dorsal nucleus of the vagus nerve in the medulla oblongata, emit nerve fibers and connect to the postganglionic nerve via the cardiac ganglion distributed in the atrial septum and left atrial posterior wall, and run medially in the ventricular muscle in opposition to the sympathetic nerves, reaching the ventricular muscles. The nucleus of the sympathetic nerve is a central nerve fiber, which runs medial to the ventricular muscle and is distributed within the ventricular muscle in opposition to the sympathetic nerve [8][9][10][11].…”

Sympathetic Nervous System and Atherosclerosis

“…PAD, also known as atherosclerotic occlusive disease of the lower extremities, affects more than 200 million people worldwide [133]. Patients with PAD display cardiac autonomic dysfunction [134], increased sympathetic nerve activity, and an augmented blood pressure response to exercise [135,136]. The increase in sympathetic nerve activity in PAD is associated with an increase in sensory nerve receptors (e.g., receptor potential vanilloid type 1, purinergic P2X purinoceptor 3, and acid-sensing ion channel subtype 3) [137].…”

Myths and methodologies: Cardiopulmonary exercise testing for surgical risk stratification in patients with an abdominal aortic aneurysm; balancing risk over benefit

“…On the contrary, the BP response to exercise appears to be normal [i.e., equivalent to agematched controls (Bailey et al, 2018) or when normalized relative to energy expenditure (Myers et al, 2011)]. This is surprising, given that human thoracic aortic dissection and peripheral arterial disease, which are typically associated with AAA disease (Takagi et al, 2016), are characterized by elevations in basal and exercise-induced systemic and regional aortic sympathetic activity (Qin et al, 2022;Zhipeng et al, 2014). Indeed, an exaggerated exercise pressor reflex, a peripheral neural reflex originating in skeletal muscle that encompasses the metaboreflex and the mechanoreflex (Smith et al, 2006), contributes to the more marked elevation in (exerciseinduced) muscle sympathetic nerve activity and BP consistently observed in patients with peripheral arterial disease (Baccelli et al, 1999;Cui et al, 2021).…”