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Sympathoadrenal activity, catecholamines, and the pathogenesis of vasculopathic hypertensive target-organ damage
1Department of Medicine, State University of New York, Buffalo.
Insights
Hypertension damages vital organs through hypertensive vasculopathy. Norepinephrine from the sympathoadrenal system may be a key, overlooked risk factor contributing to this vascular damage.
Area of Science:
- Cardiovascular Science
- Nephrology
- Ophthalmology
- Neurology
Background:
- Hypertension (high blood pressure) poses significant risks to major organs beyond the heart, including the kidneys, eyes, and brain.
- Damage to these target organs is often categorized under the umbrella term 'hypertensive vasculopathy'.
- The precise mechanisms driving hypertensive vasculopathy remain incompletely elucidated, with likely contributions from mechanical stress and humoral factors.
Purpose of the Study:
- To review the evidence linking organ damage in hypertension to hypertensive vasculopathy.
- To explore the role of the sympathoadrenal system and its mediators in the pathogenesis of hypertensive vasculopathy.
- To propose norepinephrine as a significant, yet underappreciated, contributor to hypertensive vasculopathy and cardiovascular risk.
Main Methods:
- Literature review of existing research on hypertension, target organ damage, and vasculopathy.
- Analysis of the proposed mechanisms involving mechanical and humoral factors.
- Examination of the impact of the sympathoadrenal system, including catecholamines like norepinephrine, on vascular health.
Main Results:
- Evidence supports grouping hypertension-induced organ damage under hypertensive vasculopathy.
- The sympathoadrenal system and catecholamines demonstrate deleterious effects on blood vessels, potentially promoting thrombosis.
- Norepinephrine is hypothesized as a primary driver of hypertensive vasculopathy and a critical cardiovascular risk factor.
Conclusions:
- Hypertensive vasculopathy is a unifying concept for organ damage in hypertension.
- The sympathoadrenal system, particularly norepinephrine, plays a crucial role in the development of hypertensive vasculopathy.
- Antihypertensive drug selection should consider their effects on the sympathoadrenal system to optimize patient outcomes.
Abstract:
In addition to the heart, the kidneys, eyes, and brain are the target organs of concern in people with hypertension. This review examines the evidence that damage to these organs can be grouped under the basic heading of hypertensive vasculopathy. The pathogenesis of hypertensive vasculopathy is incompletely understood, but probably involves both mechanical and humoral factors. The sympathoadrenal system and catecholamines have several potentially deleterious effects on large and small blood vessels and may promote thrombotic events. The hypothesis is put forward that norepinephrine is a major contributor to hypertensive vasculopathy and an overlooked cardiovascular risk factor. Choosing the optimal antihypertensive drugs may require considering the impact of the drugs on the sympathoadrenal system.