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Autonomic imbalance, hypertension, and cardiovascular risk
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0356, USA.
Insights
Essential hypertension increases cardiovascular risk due to autonomic imbalance. Targeting high sympathetic tone with metabolically beneficial antihypertensive drugs is a reasonable clinical approach for patients with metabolic syndrome.
Area of Science:
- Cardiology
- Autonomic Neuroscience
- Metabolic Syndrome
Background:
- Essential hypertension is linked to increased cardiovascular morbidity and mortality.
- Autonomic imbalance, particularly high sympathetic tone, contributes to hypertension's development and cardiac risks.
- Sympathetic overactivity underlies metabolic, hemodynamic, and rheologic abnormalities in hypertension.
Purpose of the Study:
- To investigate the role of autonomic imbalance in essential hypertension.
- To explore methods for clarifying prereceptor versus receptor abnormalities in insulin resistance.
- To evaluate the clinical utility of antihypertensive drugs in managing hypertension-related complications.
Main Methods:
- Review of existing literature on autonomic function in hypertension.
- Analysis of the contribution of sympathetic tone to hypertensive abnormalities.
- Consideration of clinical trial data and therapeutic strategies.
Main Results:
- Autonomic imbalance and high sympathetic tone are common in essential hypertension.
- Sympathetic overactivity is implicated in various metabolic and hemodynamic derangements.
- Further research is needed on newer antihypertensive medications.
Conclusions:
- Antihypertensive drugs that reduce sympathetic overactivity and offer metabolic benefits are a viable option.
- This approach is particularly relevant for hypertensive patients with metabolic syndrome or autonomic imbalance.
- Clinical trials evaluating newer medications are ongoing but results are pending.
Abstract:
Essential hypertension conveys an increased risk of cardiovascular morbidity and mortality. The common finding of an autonomic imbalance in these patients contributes not only to the etiology of hypertension itself, but also to the cardiac risk and resulting adverse sequelae. A high sympathetic tone in particular is responsible for many of the metabolic, hemodynamic, trophic, and rheologic abnormalities that cluster in patients with high blood pressure. Methods to clarify the respective importance of prereceptor versus receptor abnormalities for the etiology of insulin resistance are warranted. Results of large hypertension clinical trials examining the degree of cardioprotection offered by newer medications that are neutral or beneficial to the vast array of underlying abnormalities are a few years away. In the meantime, utilization of antihypertensive drugs that reduce sympathetic overactivity and are metabolically beneficial is a reasonable clinical alternative in hypertensive patients with the metabolic syndrome or with signs of autonomic imbalance.