Angiotensin-sympathetic system interactions in cardiovascular and metabolic disease

Giuseppe Mancia1, Raffaella Dell'Oro, Fosca Quarti-Trevano

  • 1Clinica Medica, Dipartimento Universitario di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Ospedale S. Gerardo dei Tintori (Monza), Università Milano Bicocca, Milan, Italy. guiseppe.mancia@unimib.it

Insights

The renin-angiotensin axis and sympathetic nervous system interact to regulate blood pressure. Blocking this interaction benefits cardiovascular and metabolic health.

Area of Science:

  • Cardiovascular Physiology
  • Neuroendocrinology

Background:

  • Blood pressure and volume homeostasis are significantly influenced by the renin-angiotensin axis and sympathetic nervous system.
  • Complex interactions between these systems are crucial for homeostatic modulation.

Purpose of the Study:

  • Review the physiological and pathophysiological relevance of angiotensin-sympathetic crosstalk.
  • Examine the clinical significance of these interactions in various diseases.
  • Investigate the effects of angiotensin II on adrenergic function as potential therapeutic targets.

Main Methods:

  • Literature review of physiological, pathophysiological, and clinical data.
  • Analysis of interactions between the renin-angiotensin axis and sympathetic nervous system.
  • Examination of therapeutic implications of targeting these pathways.

Main Results:

  • Angiotensin-sympathetic crosstalk plays a key role in cardiovascular regulation.
  • Interactions are relevant in both cardiovascular and non-cardiovascular diseases.
  • Angiotensin II influences adrenergic function, offering therapeutic targets.

Conclusions:

  • Blocking the renin-angiotensin system favorably impacts hemodynamic, metabolic, and renal profiles.
  • These interventions are important for treating hypertension, heart failure, renal insufficiency, and metabolic syndrome.
Abstract

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
Hypertension II: Pathophysiology01:29

Hypertension II: Pathophysiology

Hypertension is a chronic condition in which the blood's force against artery walls is excessively high, posing risks such as heart disease. The condition's underlying mechanisms involve complex interactions among the cardiovascular, kidney, and autonomic nervous systems.Renin-Angiotensin-Aldosterone System (RAAS): This system significantly influences blood pressure regulation. When blood pressure decreases, the kidneys secrete renin. This enzyme transforms angiotensinogen, a plasma protein,...
Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
Hormonal Regulation of Blood Pressure01:17

Hormonal Regulation of Blood Pressure

Endocrinal or hormonal intervention in the cardiovascular system is predominantly exerted by the catecholamines - epinephrine and norepinephrine, as well as a slew of hormones that interact with renal function to modulate blood volume.
Epinephrine and Norepinephrine
The adrenal medulla releases epinephrine and norepinephrine, catecholamines that enhance and extend the sympathetic or "fight or flight" physiological response. These hormones escalate heart rate and the force of contraction while...
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...