Current Clinical Pharmacology - Volume 8, Issue 3, 2013

Despite the well documented and very effective non pharmacologic and pharmacologic therapies, hypertension remains often poorly controlled. There is still room for improvements in blood pressure control and recent technological advances have generated a regained interest in the physiopathology of renal sympathetic innervation in hypertension. In this article we review the evidence that renal sympathetic activity i Read More

The present paper reviews the techniques allowing to assess sympathetic activity in humans, highlighting their advantages and limitations. While plasma noradrenaline measurement represents a useful and widely used method to evaluate sympathetic neural function, new approaches, developed starting from the seventies, like direct recording of sympathetic nerve traffic and noradrenaline spillover. These approaches Read More

The sympathetic nervous system has a profound effect on the kidney’s ability to regulate blood pressure and, vice versa, the kidney has an important effect on the overall sympathetic tone. As a result, renal sympathetic nerves are crucial for initiation and the maintenance of systemic hypertension. It is fairly well established that efferent renal sympathetic nerve activity contributes significantly to homeostatic regulation Read More

The kidney has been shown to be critically involved as both trigger and target of sympathetic nervous system overactivity in both experimental and clinical studies. Renal injury and ischemia, activation of renin angiotensin system and dysfunction of nitric oxide system have been implicated in adrenergic activation from kidney. Conversely, several lines of evidence suggest that sympathetic overactivity, through functional and m Read More

In the present review article we address the issue of the potential effect of renal sympathetic denervation (RSD) on metabolic states associated with resistant hypertension. So far, there is an established pathophysiological background denoting that abnormalities in glucose metabolism especially in obese patients and in those with sleep apnea are constantly accompanied by increased sympathetic firing, as assessed by Read More

Resistant hypertension is frequently encountered and remains challenging in everyday clinical practice despite the availability of numerous effective antihypertensive drugs. Existing limitations in drug therapy renders renal nerve ablation (RNA) an attractive alternative for the management of resistant hypertension. RNA has been proven so far both effective and safe in small clinical studies. However, every novel technique rais Read More

Percutaneous catheter-based transluminal renal nerve ablation (RNA) by delivery of radiofrequency energy constitutes a novel therapeutic strategy for the treatment of resistant hypertension. The sympathetic nervous activation to the kidney and the sensory afferent signals to the central nervous system represent the targets of RNA. In this review we summarize current recommendations for appropriate patient selection f Read More

The metabolic syndrome is a constellation of risk factors for cardiovascular diseases including: abdominal obesity, a decreased ability to metabolize glucose (increased blood glucose levels and/or presence of insulin resistance), dyslipidemia, and hypertension. Patients who have developed this syndrome have been shown to be at an increased risk of developing cardiovascular disease and/or type 2 diabetes. Genetic factors and Read More

The amount of body fat is precisely regulated in the overall process of energy homeostasis. Multiple organ systems participate in the regulatory process. Key regulatory signals reach the brain from the blood and control food intake and energy expenditure. The hypothalamus region integrates neurohormonal signaling from gut and adipose tissue. Morbid obesity is also associated with low grade systemic inflammation Read More

Obesity is a worldwide health problem associated with substantial morbidity and cost. Lifestyle modification and pharmacotherapy for obesity have limited benefit. Bariatric surgery is effective but with substantial risks, considerable cost and limited patient applicability. Endoscopic approach to obesity has evolved as a result of an attempt to replicate some of the anatomical manipulations and the physiological effects of the trad Read More

Orally administered drugs are generally absorbed by the small intestine and transported either to the lymphatic system or to the hepatic portal system. In general, lipid soluble drugs and vitamins are transported by the small intestine to the lymphatics, and water-soluble drugs are transported to the hepatic portal system. By avoiding the early hepatic first pass effect, the lymphatic transport system may increase dr Read More

Schizophrenia is a chronic, severe and recurrent brain disorder that requires continuous, long-term treatment with antipsychotic medication to minimize relapse and provide clinical benefit to patients. For patients with schizophrenia, non-adherence to medication is a major risk factor for relapse and re-hospitalization. Long-acting injectable formulations of second-generation antipsychotics (SGAs-LAIs) provide constant me Read More