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Published on: September 11, 2018
High muscle sympathetic nerve activity is associated with left ventricular dysfunction in treated hypertensive
Silvia Beatriz Cavasin de Souza1, Juraci Aparecida Rocha, Marco Antonio Romeu Cuoco
1Heart Institute InCor, Medical School University of Sao Paulo, Sao Paulo, Brazil. sbcavasin.souza@gmail.com
Insights
Hypertension patients with asymptomatic left ventricular diastolic dysfunction (LVDD) show increased muscle sympathetic nerve activity (MSNA), regardless of blood pressure control. This heightened sympathetic activity is similar across different LVDD types.
Area of Science:
- Cardiology
- Hypertension Research
- Autonomic Nervous System Studies
Background:
- Asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients is linked to cardiac events.
- Increased sympathetic activity may contribute to these cardiac outcomes.
- This study investigates the relationship between LVDD and sympathetic activity in hypertension.
Purpose of the Study:
- To determine if sympathetic activity is elevated in hypertensive patients with LVDD, independent of blood pressure control.
- To assess if different classes of LVDD differentially affect sympathetic activity.
- To explore the role of autonomic dysfunction in hypertensive cardiovascular risk.
Main Methods:
- 45 hypertensive patients were categorized into normal function, impaired relaxation, and pseudonormal/restrictive LVDD groups based on echo Doppler.
- A control group of 14 normotensive volunteers was included.
- Muscle sympathetic nerve activity (MSNA), heart rate, and blood pressure variability, and baroreflex sensitivity were measured.
Main Results:
- Hypertensive patients with impaired relaxation or pseudonormal/restrictive LVDD exhibited significantly higher MSNA compared to those with normal function and controls.
- Blood pressure and antihypertensive medication use were comparable across hypertensive LVDD groups.
- Elevated MSNA was observed independently of blood pressure control.
Conclusions:
- Asymptomatic LVDD in hypertensive individuals is associated with increased sympathetic nerve activity.
- This sympathetic hyperactivity is consistent across various patterns of LVDD.
- LVDD represents a state of autonomic dysregulation in hypertensive patients, potentially increasing cardiovascular risk.
Background:
The presence of asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients can be associated with the development of cardiac events. The increase in sympathetic activity may be 1 of the mechanisms that predisposes to this outcome. In this study, we analyzed 2 hypotheses: (i) whether sympathetic activity is higher in the presence of LVDD, independent of blood pressure control and (ii) whether different classes of LVDD have a different effect on sympathetic activity.
Methods:
After analyzing left ventricular function using echo Doppler cardiography, 45 hypertensive patients receiving treatment were allocated into 3 groups: normal function (LV-NF, n = 15), impaired relaxation (LV-IR, n = 15), and pseudonormal or restrictive (LV-P/R, n = 15). An age-, sex-, and body mass index-matched control group of normotensive volunteers (N, n = 14) was included. Muscle sympathetic nerve activity (MSNA), heart rate, and systolic blood pressure variabilities and baroreflex sensitivity were evaluated while the patient was in a supine position.
Results:
Blood pressure and antihypertensive drug use were similar among the hypertensive groups. The LV-IR and LV-P/R groups had similar MSNA (33±1 and 32±1 bursts/min, respectively), which was significantly higher than that of the LV-NF and N groups (26±3 and 15±2 bursts/min, respectively). The LV-IR and LV-P/R groups had significantly higher LF-systolic blood pressure variability and significantly lower baroreflex sensitivity compared with the N group.
Conclusions:
The presence of asymptomatic LVDD is associated with increased MSNA, independent of blood pressure control. The sympathetic hyperactivity associated with LVDD is similar in the different patterns of LVDD studied.
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