title: Neurovascular decompression of the rostral ventrolateral medulla decreases blood pressure and sympathetic nerve activity in patients with refractory hypertension.
abstract: Recently, the authors experienced four patients who had refractory hypertension and neurovascular compression of the rostral ventrolateral medulla (RVLM). One of them, a 49-year-old woman, had undergone continuous intravenous drip injections of calcium channel blockers and β-blockers for more than 3 years because of severe and refractory hypertension. The patients had undergone microvascular decompression (MVD) of the RVLM, and the changes in blood pressure (BP) and sympathetic nerve activities were recorded. In these patients, BP decreased to the normal range without any antihypertensive drugs 2 to 3 months after MVD. The tibial sympathetic nerve activities under resting and stress conditions significantly decreased, and plasma levels of norepinephrine, urinary levels of adrenaline, and plasma renin activity were also significantly decreased after MVD of RVLM. In some patients with refractory hypertension, arterial compression of the RVLM enhances sympathetic nerve activity and renin-angiotensin system to thereby increase BP. In these patients, the operative decompression of the RVLM could lower BP via restoration of sympathetic nerve activities and the renin-angiotensin system.
authors: Division of Medicine, Akashi Municipal Hospital, Kyoto, Japan. s.sasaki@city.akashi.lg.jp
authors: Susumu
authors: S
authors: Sasaki
authors: Shuji
authors: S
authors: Tanda
authors: Tsuguru
authors: T
authors: Hatta
authors: Satoshi
authors: S
authors: Morimoto
authors: Kazuo
authors: K
authors: Takeda
authors: Osamu
authors: O
authors: Kizu
authors: Shinji
authors: S
authors: Tamaki
authors: Mitsuru
authors: M
authors: Saito
authors: Yoji
authors: Y
authors: Tamura
authors: Akinori
authors: A
authors: Kondo
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D004837:Epinephrine / Q000652:urine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology / Q000601:surgery*; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000502:physiology; D013564:Sympathetic Nervous System / Q000502:physiology*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D012083:Renin; D009638:Norepinephrine; D004837:Epinephrine