New possibilities of non-drug therapy of arterial hypertension?

Abstract

The hyperactivity sympathetic nervous system has a significant role in the pathogenesis of essential hypertension. Factors that account for increase in sympathetic activity are present not only in early and borderline hypertension but also contribute to the maintenance of sustained hypertension. Patients with borderline hypertension, particularly when they are young, have a faster heart rate and hyperdynamic circulation associated with increased levels of norepinephrine in blood. Measurement of cardiac and kidney catecholamine release revealed sympathetic overactivity and microneurography showed revealed sympathetic nerve activity in hypertensive humans. Moreover, several cardiovascular and renal risk factors such as left ventricular hypertrophy, disorders of cardiac rhythm, sudden death, sodium and water reabsorption from proximal tubules frequently associated with hypertension are etiologically linked to sympathetic activation. The modification of lifestyle, specially overweight reduction and increase of physical activity diminishe sympathetic tone and reduce blood pressure. Also slow breathing may reduce high blood pressure. The recent studies have demonstrated that prolonged baroreflex activation (by chronic electrical stimulation of the afferent limb of the carotid baroreflex) reduced normal and high blood pressure in experimental animals. Clinical trials are now underway to evaluate the efficacy of this new nonpharmacological treatment of hypertension.