title: The sympathetic nervous system alterations in human hypertension.
abstract: Several articles have dealt with the importance and mechanisms of the sympathetic nervous system alterations in experimental animal models of hypertension. This review addresses the role of the sympathetic nervous system in the pathophysiology and therapy of human hypertension. We first discuss the strengths and limitations of various techniques for assessing the sympathetic nervous system in humans, with a focus on heart rate, plasma norepinephrine, microneurographic recording of sympathetic nerve traffic, and measurements of radiolabeled norepinephrine spillover. We then examine the evidence supporting the importance of neuroadrenergic factors as promoters and amplifiers of human hypertension. We expand on the role of the sympathetic nervous system in 2 increasingly common forms of secondary hypertension, namely hypertension associated with obesity and with renal disease. With this background, we examine interventions of sympathetic deactivation as a mode of antihypertensive treatment. Particular emphasis is given to the background and results of recent therapeutic approaches based on carotid baroreceptor stimulation and radiofrequency ablation of the renal nerves.
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Carver College of Medicine, University of Iowa, Iowa City (A.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Australia (M.E.). guido.grassi@unimib.it.
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Carver College of Medicine, University of Iowa, Iowa City (A.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Australia (M.E.).
authors.forename: Allyn
authors.initials: A
authors.lastname: Mark
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Carver College of Medicine, University of Iowa, Iowa City (A.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Australia (M.E.).
authors.forename: Murray
authors.initials: M
authors.lastname: Esler
mesh_terms: D000818:Animals; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003935:Diagnostic Techniques, Cardiovascular; D005544:Forecasting; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006946:Hyperinsulinism / Q000503:physiopathology; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006977:Hypertension, Renal / Q000503:physiopathology / Q000601:surgery; D007333:Insulin Resistance / Q000502:physiology; D007668:Kidney / Q000294:innervation; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology; D020738:Leptin / Q000172:deficiency / Q000502:physiology; D053486:Melanocortins / Q000502:physiology; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology; D015337:Multicenter Studies as Topic; D059906:Neuroimaging; D009638:Norepinephrine / Q000097:blood; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D013562:Sympathectomy / Q000379:methods; D017779:Sympathetic Fibers, Postganglionic / Q000502:physiology; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014661:Vasoconstriction / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents; D020738:Leptin; D053486:Melanocortins; D009638:Norepinephrine
keywords: hypertension essential; renal insufficiency; sympathetic nervous system