Autonomic nervous system activity changes in patients with hypertension and overweight: role and therapeutic implications

Paul Valensi, Paul Valensi

Abstract

The incidence and prevalence of hypertension is increasing worldwide, with approximately 1.13 billion of people currently affected by the disease, often in association with other diseases such as diabetes mellitus, chronic kidney disease, dyslipidemia/hypercholesterolemia, and obesity. The autonomic nervous system has been implicated in the pathophysiology of hypertension, and treatments targeting the sympathetic nervous system (SNS), a key component of the autonomic nervous system, have been developed; however, current recommendations provide little guidance on their use. This review discusses the etiology of hypertension, and more specifically the role of the SNS in the pathophysiology of hypertension and its associated disorders. In addition, the effects of current antihypertensive management strategies, including pharmacotherapies, on the SNS are examined, with a focus on imidazoline receptor agonists.

Keywords: Autonomic nervous system; Hypertension; Obesity; Selective imidazoline receptor agonists; Type 2 diabetes.

Conflict of interest statement

Paul Valensi discloses the following potential conflicts of interest: lectures for Abbott, AstraZeneca, Bayer, Lilly, Hikma Pharmaceuticals, Merck Sharp & Dohme, Novo Nordisk, Novartis, Pfizer, Sanofi; research grants from Abbott, Bristol-Myers-Squibb–AstraZeneca, Novo Nordisk; participation in expert committees for AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Lilly, Novo Nordisk, Sanofi, Servier, Stendo.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Control of blood pressure by the sympathetic nervous system (SNS) and the renin–angiotensin–aldosterone system (RAAS)
Fig. 2
Fig. 2
The role of the sympathetic nervous system (SNS) in energy balance and metabolic regulation, and in blood pressure control in overweight patients. FFA Free fatty acids, OSA obstructive sleep apnea, RAAS renin–angiotensin–aldosterone. Red crosses designate a disruption
Fig. 3
Fig. 3
Mechanisms of action of imidazoline receptor agonists
Fig. 4
Fig. 4
Metabolic and cardiovascular effects of selective imidazoline receptor agonists moxonidine and rilmenidine

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