Central sympathetic inhibition by mineralocorticoid receptor but not angiotensin ii type 1 receptor blockade: Are prescribed doses too low?

摘要

Chronic sympathetic hyperactivity, characteristic of the majority of patients with hypertension or heart failure, can contribute to cardiovascular morbidity and mortality via a number of actions. Pharmacological strategies to prevent these adverse effects have had variable success. beta-Blockers clearly benefit patients with heart failure but have less definitive effects in patients with hypertension, whereas alpha_1-blockers or centrally acting agents have shown mixed results, and all of these classes can cause bothersome adverse effects. Device-based approaches, such as baroreflex activation therapy and renal denervation, have been shown to lower sympathetic activity in patients with hypertension, but beneficial actions on cardiovascular outcomes have yet to be demonstrated.