This Article Full Text Full Text (PDF) All Versions of this Article: 43/2/154    most recent 01.HYP.0000109870.99110.7ev1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grassi, G. Articles by Mancia, G. Search for Related Content PubMed PubMed Citation Articles by Grassi, G. Articles by Mancia, G. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information High Blood Pressure Related Collections Clinical Studies Autonomic, reflex, and neurohumoral control of circulation

(Hypertension. 2004;43:154.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Neurogenic Hypertension: Is the Enigma of Its Origin Near the Solution?

From the Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Monza (Milano), Centro Interuniversitario di Fisiologia Clinica e Ipertensione and Centro Auxologico Italiano, Milano, Italy.

Correspondence to Professor Guido Grassi, Clinica Medica, Ospedale S. Gerardo dei Tintori, Via Donizetti 106, 20052 Monza (MI), Italia. E-mail guido.grassi@unimib.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Since the demonstrationthat the sympathetic nervous system exerts a fundamental role in the homeostatic control of blood pressure, the hypothesis has been advanced that abnormalities in the adrenergic regulation of either cardiac output or peripheral vascular resistance might represent the pathophysiological hallmarks of the essential hypertensive state of "neurogenic" nature. To date, the evidence supporting this hypothesis can be summarized as follows. First, the early stages of hypertension frequently display hyperkinetic circulation characterized by an increase in cardiac output coupled with an elevated heart rate (ie, by hemodynamic abnormalities that have been shown to be triggered by a blunted parasympathetic and an enhanced sympathetic cardiovascular drive).¹ Second, a meta-analysis of all published studies that have made use of plasma norepinephrine assay for evaluating adrenergic tone has provided evidence that, even accounting for some negative results, an indirect marker of the sympathetic function, such as plasma norepinephrine, is significantly elevated in essential hypertensive patients as compared with age-matched normotensive controls.² Third, by using the technique based on the intravenous tracer infusion of small doses of radiolabeled norepinephrine, it has been possible to show³ that the rate of norepinephrine spillover from the sympathetic neuroeffector junctions is augmented in young subjects with borderline blood pressure elevation and that this enhanced release is particularly manifest in the kidney and in the heart (ie, in two organs of key importance in the homeostatic process of blood pressure control). Fourth, hypertensive patients display at the ¹²³I-metaiodobenzylguanidine cardiac imaging technique a lower uptake and a greater washout . . . [Full Text of this Article]

This article has been cited by other articles:

				H. Li, Y. Gao, Y. Qi, M. J. Katovich, N. Jiang, L. N. Braseth, D. A. Scheuer, P. Shi, and C. Sumners Macrophage migration inhibitory factor in hypothalamic paraventricular nucleus neurons decreases blood pressure in spontaneously hypertensive rats FASEB J, September 1, 2008; 22(9): 3175 - 3185. [Abstract] [Full Text] [PDF]

				G. Grassi, F. Quarti-Trevano, and G. Mancia Review: Cardioprotective effects of telmisartan in uncomplicated and complicated hypertension Journal of Renin-Angiotensin-Aldosterone System, June 1, 2008; 9(2): 66 - 74. [Abstract] [PDF]

				A L Markel, O E Redina, M A Gilinsky, G M Dymshits, E V Kalashnikova, Y. V Khvorostova, L A Fedoseeva, and G S Jacobson Neuroendocrine profiling in inherited stress-induced arterial hypertension rat strain with stress-sensitive arterial hypertension J. Endocrinol., December 1, 2007; 195(3): 439 - 450. [Abstract] [Full Text] [PDF]

				G. Grassi Qualitative Assessment of Sympathetic Neural Drive in Cardiometabolic Disease: A New Challenge Hypertension, November 1, 2007; 50(5): 835 - 836. [Full Text] [PDF]

				G. Grassi Adrenergic Overdrive as the Link Among Hypertension, Obesity, and Impaired Thermogenesis: Lights and Shadows Hypertension, January 1, 2007; 49(1): 5 - 6. [Full Text] [PDF]

				D. A. Heaton, M. Lei, D. Li, S. Golding, T. A. Dawson, R. M. Mohan, and D. J. Paterson Remodeling of the Cardiac Pacemaker L-Type Calcium Current and Its {beta}-Adrenergic Responsiveness in Hypertension After Neuronal NO Synthase Gene Transfer Hypertension, September 1, 2006; 48(3): 443 - 452. [Abstract] [Full Text] [PDF]