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Sympathetic nervous system function in renal hypertension
Meryem Tuncel1, Robert Augustyniak, Weiguo Zhang
1Hypertension Division, Department of Internal Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room J4.134, Dallas, TX 75390-8586, USA.
Current Hypertension Reports
|May 11, 2002
Summary
Hypertension in chronic kidney disease involves sympathetic overactivity. Angiotensin converting enzyme inhibitors normalized this, unlike amlodipine, suggesting a therapeutic role for managing sympathetic nerves to improve kidney and heart health.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Neuroscience
Background:
- Hypertension is a significant complication of chronic renal failure (CRF), worsening kidney function and increasing cardiovascular risks.
- Traditional views attribute renal hypertension primarily to volume overload, but emerging evidence points to a substantial sympathetic nervous system (SNS) role.
- Understanding the pathogenesis and treatment of renal hypertension remains incomplete, particularly regarding the SNS contribution.
Purpose of the Study:
- To investigate the role of the sympathetic nervous system in hypertension associated with chronic renal insufficiency.
- To compare the effects of different antihypertensive medications on sympathetic activity in patients with renal hypertension.
- To explore the potential therapeutic implications of modulating sympathetic activity for renoprotection and cardiovascular outcomes in CRF.
Main Methods:
- Microneurography was used to assess sympathetic nerve activity in hypertensive patients with varying degrees of chronic renal insufficiency.
- A small cohort of patients with moderate chronic renal insufficiency and renin-dependent hypertension received monotherapy with either an angiotensin converting enzyme inhibitor (enalapril) or a dihydropyridine calcium channel blocker (amlodipine).
- Sympathetic activity was monitored before and during antihypertensive treatment.
Main Results:
- Microneurographic studies revealed sympathetic overactivity in hypertensive patients with chronic hemodialysis and less advanced renal insufficiency, without baroreflex impairment.
- In patients with moderate renal insufficiency and renin-dependent hypertension, enalapril normalized sympathetic overactivity.
- Amlodipine exacerbated sympathetic overactivity in the same patient group.
Conclusions:
- The sympathetic nervous system plays a significant role in renal hypertension, beyond volume dependence.
- Antihypertensive agents that block the renin-angiotensin system, like enalapril, may offer renoprotective benefits by normalizing sympathetic activity.
- Targeting and normalizing sympathetic activity could be a crucial therapeutic strategy for improving renal and cardiovascular outcomes in patients with chronic renal failure.