title: Clinical utility of sympathetic blockade in cardiovascular disease management.
abstract: A dysregulated sympathetic nervous system is a major factor in the development and progression of cardiovascular disease; thus, understanding the mechanism and function of the sympathetic nervous system and appropriately regulating sympathetic activity to treat various cardiovascular diseases are crucial. Areas covered: This review focused on previous studies in managing hypertension, atrial fibrillation, coronary artery disease, heart failure, and perioperative management with sympathetic blockade. We reviewed both pharmacological and non-pharmacological management. Expert commentary: Chronic sympathetic nervous system activation is related to several cardiovascular diseases mediated by various pathways. Advancement in measuring sympathetic activity makes visualizing noninvasively and evaluating the activation level even in single fibers possible. Evidence suggests that sympathetic blockade still has a role in managing hypertension and controlling the heart rate in atrial fibrillation. For ischemic heart disease, beta-adrenergic receptor antagonists have been considered a milestone drug to control symptoms and prevent long-term adverse effects, although its clinical implication has become less potent in the era of successful revascularization. Owing to pathologic involvement of sympathetic nervous system activation in heart failure progression, sympathetic blockade has proved its value in improving the clinical course of patients with heart failure.
authors.affiliation: a Department of Internal Medicine , Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Korea.
authors.forename: Chan Soon
authors.initials: CS
authors.lastname: Park
authors.affiliation: a Department of Internal Medicine , Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Korea.
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Lee
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D013564:Sympathetic Nervous System / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Atrial fibrillation; cardiovascular disease; coronary artery disease; heart failure; hypertension; sympathetic nervous system; sympathetic-blocking agents