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Titolo:
Autonomic dysregulation in essential hypertension: insight from heart rateand arterial pressure variability
Autore:
Pagani, M; Lucini, D;
Indirizzi:
Univ Milan, CNR, Osped L Sacco, I-20157 Milan, Italy Univ Milan Milan Italy I-20157 CNR, Osped L Sacco, I-20157 Milan, Italy Univ Milan, Ctr Ric Terapia Neurovegetat, Dept Internal Med, I-20157 Milan, Italy Univ Milan Milan Italy I-20157 , Dept Internal Med, I-20157 Milan, Italy
Titolo Testata:
AUTONOMIC NEUROSCIENCE-BASIC & CLINICAL
fascicolo: 1-2, volume: 90, anno: 2001,
pagine: 76 - 82
SICI:
1566-0702(20010720)90:1-2<76:ADIEHI>2.0.ZU;2-J
Fonte:
ISI
Lingua:
ENG
Soggetto:
SYMPATHETIC-NERVE ACTIVITY; HIGH BLOOD-PRESSURE; CARDIOVASCULAR VARIABILITIES; MILD HYPERTENSION; SPECTRAL-ANALYSIS; NEURAL CONTROL; IDENTIFICATION; OSCILLATIONS; COMPONENTS; INTERVAL;
Keywords:
spectral analysis; autonomic nervous system; sympathetics; parasympathetics; baroreflex; clinical management;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Pagani, M Univ Milan, Ctr Ric Terapia Neurovegetat, Dept Internal Med, ViaGB Grassi74, I-20157 Milan, Italy Univ Milan Via GB Grassi 74 Milan ItalyI-20157 57 Milan, Italy
Citazione:
M. Pagani e D. Lucini, "Autonomic dysregulation in essential hypertension: insight from heart rateand arterial pressure variability", AUTON NEURO, 90(1-2), 2001, pp. 76-82

Abstract

Essential hypertension is the most prevalent cardiovascular disorder, affecting more than 50 million people in the USA. Hypertension-related mortality and morbidity figures have been greatly improved over the last three decades by major advances in prevention. Detection and operative suggestions for practicing physicians are available from several guideline treatments derived from grouped data obtained in numerous well-conducted studies on largenumbers of patients. However, the disappointing results of some forms of antihypertensive therapies, particularly in preventing coronary artery disease, has shed some doubts on traditional approaches to managing hypertensivepatients. At present, in spite of extensive investigations, the exact causal mechanism(s) are far from being fully understood, and consequently, essential hypertension is still managed using a heuristic approach. Persistent elevations in arterial pressure imply some disturbances in the complex and multifactorial cardiovascular control mechanisms. In this context, neurohumoral disturbances might play a special role, in view of the demonstration that an elevated sympathetic drive seems essential in hypertensive patients. In this review, we follow the hypothesis that other allied methods capableof quantitatively assessing some aspects of the regulatory system might support and integrate the usual dichotomous diagnostic procedure based on arterial pressure determinations. In prior studies, we reported that parameters obtained by spectral analysis of heart rate variability (HRV) might furnish useful information on autonomic normal and abnormal nervous system. regulation. In the foregoing, we summarize our experience using this approach in the clinical management of hypertensive patients. It is our tenet that spectral analysis of mono or multivariate cardiovascular beat-by-beat variabilities provides potentially important information on alterations in neural control of the circulation accompanying essential hypertension. In spite ofan ongoing debate on the interpretation of specific aspects of HRV spectral components, overall, it appears that the available evidence supports the hypothesis that in essential hypertension, there is an increased sympathetic and reduced vagal cardiac drive coupled with an enhancement of vasomotor sympathetic modulation. Prospective studies on large populations, rendered more easy to perform, thanks to improvements in technology and telemedicineapplications, might provide an answer to the still open question of how toapply spectral analysis of HRV to a better mechanistic understanding of essential hypertension, and to more satisfactory individually tailored antihypertensive treatments. (C) 2001 Published by Elsevier Science B.V.

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Documento generato il 28/03/20 alle ore 23:31:55