title: Neurohormonal axis in patients with pulmonary arterial hypertension: friend or foe?
abstract: Despite its description some 25 years ago, neurohormonal activation has long been neglected as an important factor in the pathophysiology of pulmonary arterial hypertension (PAH). Neurohormonal activation was interpreted as a necessary compensatory response to maintain cardiac contractility and systemic blood pressure. Therefore, inhibitors of neurohormonal activity (like β-blockers or angiotensin-converting enzyme inhibitors) are considered contraindicated in current PAH management guidelines. However, recent data revealed that sympathetic overstimulation is strongly related to mortality, and blockade of neurohormonal activity in experimental PAH improved survival and cardiac function. These novel insights shed new light on the role of neurohormonal activity in PAH.
authors.affiliation: Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands. fs.deman@vumc.nl
authors.forename: Frances S
authors.initials: FS
authors.lastname: de Man
authors.forename: M Louis
authors.initials: ML
authors.lastname: Handoko
authors.forename: Christophe
authors.initials: C
authors.lastname: Guignabert
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Bogaard
authors.forename: Anton
authors.initials: A
authors.lastname: Vonk-Noordegraaf
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000804:Angiotensin II / Q000502:physiology; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D018377:Neurotransmitter Agents / Q000502:physiology*; D011945:Receptors, Angiotensin / Q000502:physiology; D012084:Renin-Angiotensin System / Q000502:physiology; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists; D018377:Neurotransmitter Agents; D011945:Receptors, Angiotensin; D000804:Angiotensin II