抗高血压治疗未能恢复正常交感神经活动。

IF 6.9 1区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Hypertension Pub Date : 2025-06-01 Epub Date: 2025-04-18 DOI:10.1161/HYPERTENSIONAHA.124.24429
Fosca Quarti-Trevano, Gino Seravalle, Rita Facchetti, Konstantinos Tsioufis, Kyriakos Dimitriadis, Eleni Manta, Giuseppe Mancia, Guido Grassi
{"title":"抗高血压治疗未能恢复正常交感神经活动。","authors":"Fosca Quarti-Trevano, Gino Seravalle, Rita Facchetti, Konstantinos Tsioufis, Kyriakos Dimitriadis, Eleni Manta, Giuseppe Mancia, Guido Grassi","doi":"10.1161/HYPERTENSIONAHA.124.24429","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sympathetic deactivation represents a major goal of antihypertensive drug treatment. However, whether treatment normalizes the hypertension-related sympathetic cardiovascular overdrive remains uncertain.</p><p><strong>Methods: </strong>In 219 middle-aged essential hypertensives, we analyzed, along with office systolic and diastolic blood pressure (BP) and heart rate, muscle sympathetic nerve traffic (MSNA, microneurography) before and after 3-month treatment, either as monotherapy or as combination. Controls were represented by 100 age-matched normotensives.</p><p><strong>Results: </strong>Treatment caused, along with a small heart rate decrease, a clear BP reduction (from 160.5/95.5 to 142.3/85.0 mm Hg, <i>P</i><0.01) and a significant MSNA inhibition (from 70.7±11.5 to 65.0±10.2 bursts/100 heartbeats, mean±SD, <i>P</i><0.01). A similar pattern was detected in patients under monotherapy (n=81) or combination drug treatment (n=138). MSNA was significantly related to systolic BP before and during treatment but unrelated to heart rate. In treated patients achieving the lower BP (135.1/84.5 mm Hg, n=90), the MSNA reduction was greater than that detected in patients with the higher on-treatment BP (146.7/87.4 mm Hg, n=129). However, even in patients achieving a BP target <140/90 mm Hg, MSNA remained markedly higher (on average +66.4%) compared with controls. This was the case even when treated BP was <130/80 mm Hg. Data were similar for different antihypertensive drug classes.</p><p><strong>Conclusions: </strong>Thus, antihypertensive treatment, even when effective in achieving BP control, fails to restore the level of normotension-related MSNA, with a persistence of the pattern of heightened sympathetic influences typical of untreated patients with hypertension. Failure of normalization may contribute to the development of the residual cardiovascular risk reported in treated hypertensives.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"82 6","pages":"1024-1034"},"PeriodicalIF":6.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Failure of Antihypertensive Treatment to Restore Normal Sympathetic Activity.\",\"authors\":\"Fosca Quarti-Trevano, Gino Seravalle, Rita Facchetti, Konstantinos Tsioufis, Kyriakos Dimitriadis, Eleni Manta, Giuseppe Mancia, Guido Grassi\",\"doi\":\"10.1161/HYPERTENSIONAHA.124.24429\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sympathetic deactivation represents a major goal of antihypertensive drug treatment. However, whether treatment normalizes the hypertension-related sympathetic cardiovascular overdrive remains uncertain.</p><p><strong>Methods: </strong>In 219 middle-aged essential hypertensives, we analyzed, along with office systolic and diastolic blood pressure (BP) and heart rate, muscle sympathetic nerve traffic (MSNA, microneurography) before and after 3-month treatment, either as monotherapy or as combination. Controls were represented by 100 age-matched normotensives.</p><p><strong>Results: </strong>Treatment caused, along with a small heart rate decrease, a clear BP reduction (from 160.5/95.5 to 142.3/85.0 mm Hg, <i>P</i><0.01) and a significant MSNA inhibition (from 70.7±11.5 to 65.0±10.2 bursts/100 heartbeats, mean±SD, <i>P</i><0.01). A similar pattern was detected in patients under monotherapy (n=81) or combination drug treatment (n=138). MSNA was significantly related to systolic BP before and during treatment but unrelated to heart rate. In treated patients achieving the lower BP (135.1/84.5 mm Hg, n=90), the MSNA reduction was greater than that detected in patients with the higher on-treatment BP (146.7/87.4 mm Hg, n=129). However, even in patients achieving a BP target <140/90 mm Hg, MSNA remained markedly higher (on average +66.4%) compared with controls. This was the case even when treated BP was <130/80 mm Hg. Data were similar for different antihypertensive drug classes.</p><p><strong>Conclusions: </strong>Thus, antihypertensive treatment, even when effective in achieving BP control, fails to restore the level of normotension-related MSNA, with a persistence of the pattern of heightened sympathetic influences typical of untreated patients with hypertension. Failure of normalization may contribute to the development of the residual cardiovascular risk reported in treated hypertensives.</p>\",\"PeriodicalId\":13042,\"journal\":{\"name\":\"Hypertension\",\"volume\":\"82 6\",\"pages\":\"1024-1034\"},\"PeriodicalIF\":6.9000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hypertension\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/HYPERTENSIONAHA.124.24429\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hypertension","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24429","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0

摘要

背景:交感神经失活是抗高血压药物治疗的主要目标。然而,治疗是否使高血压相关的交感心血管过度驱动正常化仍不确定。方法:分析219例中年原发性高血压患者单药或联合用药3个月前后的收缩压、舒张压、心率、肌交感神经通信量(MSNA,微神经造影)。对照组由100名年龄匹配的血压正常者代表。结果:治疗导致血压明显降低(从160.5/95.5降至142.3/85.0 mm Hg, ppp)。结论:因此,降压治疗即使有效控制血压,也不能恢复与血压正常相关的MSNA水平,持续存在未治疗的高血压患者典型的交感神经影响增强模式。在治疗后的高血压患者中,血压正常化失败可能会导致剩余心血管风险的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Failure of Antihypertensive Treatment to Restore Normal Sympathetic Activity.

Background: Sympathetic deactivation represents a major goal of antihypertensive drug treatment. However, whether treatment normalizes the hypertension-related sympathetic cardiovascular overdrive remains uncertain.

Methods: In 219 middle-aged essential hypertensives, we analyzed, along with office systolic and diastolic blood pressure (BP) and heart rate, muscle sympathetic nerve traffic (MSNA, microneurography) before and after 3-month treatment, either as monotherapy or as combination. Controls were represented by 100 age-matched normotensives.

Results: Treatment caused, along with a small heart rate decrease, a clear BP reduction (from 160.5/95.5 to 142.3/85.0 mm Hg, P<0.01) and a significant MSNA inhibition (from 70.7±11.5 to 65.0±10.2 bursts/100 heartbeats, mean±SD, P<0.01). A similar pattern was detected in patients under monotherapy (n=81) or combination drug treatment (n=138). MSNA was significantly related to systolic BP before and during treatment but unrelated to heart rate. In treated patients achieving the lower BP (135.1/84.5 mm Hg, n=90), the MSNA reduction was greater than that detected in patients with the higher on-treatment BP (146.7/87.4 mm Hg, n=129). However, even in patients achieving a BP target <140/90 mm Hg, MSNA remained markedly higher (on average +66.4%) compared with controls. This was the case even when treated BP was <130/80 mm Hg. Data were similar for different antihypertensive drug classes.

Conclusions: Thus, antihypertensive treatment, even when effective in achieving BP control, fails to restore the level of normotension-related MSNA, with a persistence of the pattern of heightened sympathetic influences typical of untreated patients with hypertension. Failure of normalization may contribute to the development of the residual cardiovascular risk reported in treated hypertensives.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Hypertension
Hypertension 医学-外周血管病
CiteScore
15.90
自引率
4.80%
发文量
1006
审稿时长
1 months
期刊介绍: Hypertension presents top-tier articles on high blood pressure in each monthly release. These articles delve into basic science, clinical treatment, and prevention of hypertension and associated cardiovascular, metabolic, and renal conditions. Renowned for their lasting significance, these papers contribute to advancing our understanding and management of hypertension-related issues.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信