Neurogenic factors in hypertension: therapeutic implications

This manuscript reviews the evidence supporting a role for neurogenic factors in the pathophysiology of essential hypertension. The available evidence in human subjects is largely indirect and suggests a role for the sympathetic nervous system primarily in younger patients with borderline hypertension. In predisposed subjects, environmental factors, such as stress and high dietary salt intake, may activate the sympathetic nervous system and cause hypertension. With advancing age, vascular structural changes may contribute to the maintenance of hypertension despite a seemingly normal sympathetic nerve activity. The evidence supporting a role for neurogenic factors in the genesis of hypertension in patients with chronic renal failure has also been reviewed. Afferent stimuli from the scarred or diseased kidneys into the central nervous system may activate the sympathetic nervous system and contribute to the genesis of hypertension in patients with chronic renal failure. These observations may explain the efficacy of antiadrenergic agents in the management of hypertension in these patients.