Am J Respir Crit Care Med. 2012 Nov 9. [Epub ahead of print]
Neurohormonal Axis in Patients with Pulmonary Arterial Hypertension: Friend or Foe?
de Man FS, Handoko ML, Guignabert C, Bogaard HJ, Vonk-Noordegraaf A.

Pulmonology, VU University Medical Center, Amsterdam, Netherlands.

Abstract

Despite its description some 25 years ago, neurohormonal activation has long been neglected as an important factor in the pathophysiology of pulmonary arterial hypertension (PAH). Neurohormonal activation was interpreted as a necessary compensatory response to maintain cardiac contractility and systemic blood pressure. Therefore, inhibitors of neurohormonal activity (like β-blockers or ACE-inhibitors) are considered contra-indicated in current PAH-management guidelines. However, recent data revealed that sympathetic over-stimulation is strongly related to mortality, and blockade of neurohormonal activity in experimental PAH improved survival and cardiac function. These novel insights shed new light on the role of neurohormonal activity in PAH, and will be discussed in this Pulmonary Perspective.

PMID:23144327