Lowering of blood pressure by chronic suppression of central sympathetic outflow: insight from prolonged baroreflex activation.
Device-based therapy for resistant hypertension by electrical activation of the carotid baroreflex is currently undergoing active clinical investigation, and initial findings from clinical trials have been published. The purpose of this mini-review is to summarize the experimental studies that have provided a conceptual understanding of the mechanisms that account for the long-term lowering of arterial pressure with baroreflex activation. The well established mechanisms mediating the role of the baroreflex in short-term regulation of arterial pressure by rapid changes in peripheral resistance and cardiac function are often extended to long-term pressure control, and the more sluggish actions of the baroreflex on renal excretory function are often not taken into consideration. However, because clinical, experimental, and theoretical evidence indicates that the kidneys play a dominant role in long-term control of arterial pressure, this review focuses on the mechanisms that link baroreflex-mediated reductions in central sympathetic outflow with increases in renal excretory function that lead to sustained reductions in arterial pressure.
Department of Physiology, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, USA. tlohmeier@umc.edu
Thomas E
TE
Lohmeier
Radu
R
Iliescu
D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D062186:Arterial Pressure / Q000187:drug effects; D017704:Baroreflex; D002346:Carotid Sinus / Q000294:innervation*; D002490:Central Nervous System / Q000503:physiopathology*; D004351:Drug Resistance; D004599:Electric Stimulation Therapy; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D009765:Obesity / Q000150:complications; D012084:Renin-Angiotensin System; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D016896:Treatment Outcome; D014655:Vascular Resistance
D000959:Antihypertensive Agents