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01.07.2005 | Article

Neuroadrenergic and reflex abnormalities in patients with metabolic syndrome

verfasst von: G. Grassi, R. Dell’Oro, F. Quarti-Trevano, F. Scopelliti, G. Seravalle, F. Paleari, P. L. Gamba, G. Mancia

Erschienen in: Diabetologia | Ausgabe 7/2005

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Abstract

Aims/hypothesis

Previous studies have shown that alterations in vascular, metabolic, inflammatory and haemocoagulative functions characterise the metabolic syndrome. Whether this is also the case for sympathetic function is not clear. We therefore aimed to clarify this issue and to determine whether metabolic or reflex mechanisms might be responsible for the possible adrenergic dysfunction.

Methods

In 43 healthy control subjects (age 48.2±1.0 years, mean±SEM) and in 48 untreated age-matched subjects with metabolic syndrome (National Cholesterol Education Program’s Adult Treatment Panel III Report criteria) we measured, along with anthropometric and metabolic variables, blood pressure (Finapres), heart rate (ECG) and efferent postganglionic muscle sympathetic nerve activity (microneurography) at rest and during baroreceptor manipulation (vasoactive drug infusion technique).

Results

Compared with control subjects, subjects with metabolic syndrome had higher BMI, waist circumference, blood pressure, cholesterol, triglycerides, insulin and homeostasis model assessment (HOMA) index values but lower HDL cholesterol values. Sympathetic nerve traffic was significantly greater in subjects with metabolic syndrome than in control subjects (61.1±2.6 vs 43.8±2.8 bursts/100 heartbeats, p<0.01), the presence of sympathetic activation also being detectable when the metabolic syndrome did not include hypertension as a component. Muscle sympathetic nerve traffic correlated directly and significantly with waist circumference (r=0.46, p<0.001) and HOMA index (r=0.49, p<0.001) and was inversely related to baroreflex sensitivity (r=−0.44, p<0.001), which was impaired in the metabolic syndrome.

Conclusions/interpretation

These data provide evidence that the metabolic syndrome is characterised by sympathetic activation and that this abnormality (1) is also detectable when blood pressure is normal and (2) depends on insulin resistance as well as on reflex alterations.

Isomaa B, Almgren P, Tuomi T et al (2001) Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24:683–689PubMed

Lakka HM, Laaksonen DE, Lakka TA et al (2002) The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288:2709–2716CrossRefPubMed

Isomaa B, Henricsson M, Almgren P, Tuomi T, Taskinen MR, Groop L (2001) The metabolic syndrome influences the risk of chronic complications in patients with type II diabetes. Diabetologia 44:1148–1154

Heine RJ, Dekker JM (2002) Beyond postprandial hyperglycaemia: metabolic factors associated with cardiovascular disease. Diabetologia 45:461–475

Scott MG, Brewer HB, Cleeman JI et al (2004) Definition of metabolic syndrome. Report of the National Heart, Lung and Blood Institute/American Heart Association Conference on scientific issues related to definition. Circulation 109:433–438CrossRefPubMed

Reaven GM, Lithell H, Landsberg L (1996) Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system. N Engl J Med 334:374–381CrossRefPubMed

Landsberg L (2001) Insulin-mediated sympathetic stimulation: role in the pathogenesis of obesity-related hypertension. J Hypertens 19:523–528CrossRefPubMed

Huggett RJ, Burns J, Mackintosh AF, Mary D (2004) Sympathetic neural activation in nondiabetic metabolic syndrome and its further augmentation by hypertension. Hypertension 44:847–852CrossRefPubMed

Suter PM, Vetter W (1995) Metabolic effects of antihypertensive drugs. J Hypertens 13:S11–S17

10.

Neutel JM (1996) Metabolic manifestations of low dose diuretics. Am J Med 101:71S–82SCrossRefPubMed

11.

Grassi G, Esler MD (1999) How to assess sympathetic activity in humans. J Hypertens 17:719–734CrossRefPubMed

12.

Wallin BG, Fagius J (1988) Peripheral sympathetic neural activity in conscious humans. Annu Rev Physiol 50:565–576CrossRefPubMed

13.

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of high Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report (2002) Circulation 106:3143–3421PubMed

14.

Grassi G, Seravalle G, Cattaneo BM et al (1995) Sympathetic activation in obese normotensive subjects. Hypertension 25:560–563PubMed

15.

Grassi G, Seravalle G, Colombo M et al (1998) Body weight reduction, sympathetic nerve traffic, and arterial baroreflex in obese normotensive humans. Circulation 97:2037–2042PubMed

16.

Grassi G, Cattaneo BM, Seravalle G et al (1998) Baroreflex control of sympathetic nerve activity in essential and secondary hypertension. Hypertension 31:68–72PubMed

17.

Hjemdahl P, Daleskog M, Kahan T (1979) Determination of plasma catecholamines by high performance liquid chromatography with electrochemical detection: comparison with a radioenzymatic method. Life Sci 25:131–138CrossRefPubMed

18.

Matthews DR, Hosker JP, Rudenski AS et al (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419CrossRefPubMed

19.

Schlaich MP, Kaye DM, Lambert E et al (2003) Relation between cardiac sympathetic activity and hypertensive left ventricular hypertrophy. Circulation 108:560–565CrossRefPubMed

20.

Schlaich MP, Lambert E, Kaye DM et al (2004) Sympathetic augmentation in hypertension: role of nerve firing, norepinephrine reuptake, and angiotensin neuromodulation. Hypertension 43:169–175CrossRefPubMed

21.

Rowe JW, Young JB, Minaker KL, Stevens AL, Pallotta J, Landsberg L (1981) Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man. Diabetes 30:219–225PubMed

22.

Anderson EA, Balon TW, Hoffmann RP et al (1992) Insulin increases sympathetic activity but not blood pressure in borderline hypertensive humans. Hypertension 19:62–69PubMed

23.

Berne C, Fagius J, Pollare T, Hjemdhal P (1992) The sympathetic response to euglycaemic hyperinsulinemia. Evidence from microelectrode nerve recordings in healthy subjects. Diabetologia 35:873–879

24.

Correia ML, Haynes WG (2004) Leptin, obesity and cardiovascular disease. Curr Opin Nephrol Hypertens 13:215–223PubMed

25.

Grassi G (2004) Leptin, sympathetic nervous system and baroreflex function. Curr Hypertens Rep 6:236–240PubMed

26.

Somers VK, Dyken ME, Clary MP et al (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904PubMed

27.

Narkiewicz K, Van de Borne PJH, Cooley RL et al (1998) Sympathetic activity in obese subjects with and without obstructive sleep apnea. Circulation 98:772–776PubMed

28.

Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP (2004) Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25:709–711CrossRefPubMed

29.

Jamerson KA, Julius S, Gudbrandsson T et al (1993) Reflex sympathetic activation induces acute insulin resistance in the human forearm. Hypertension 21:618–623PubMed

30.

Julius S, Jamerson K (1994) Sympathetics, insulin resistance and coronary risk in hypertension: ‘chicken-and-egg’ question. J Hypertens 12:495–502PubMed

31.

Baron AD, Brechtel-Hook G, Johnson A et al (1996) Effect of perfusion rate on the time course of insulin-mediated skeletal muscle glucose uptake. Am J Physiol 271:E1067–E1072PubMed

32.

Brunner EJ, Hemingway H, Walker BR et al (2002) Adrenocortical autonomic and inflammatory causes of the metabolic syndrome. Circulation 106:2659–2665CrossRefPubMed

33.

Kingwell BA, Thompson JM, Kaye DM et al (1994) Heart rate spectral analysis, cardiac norepinephrine spillover and muscle sympathetic nerve activity during human sympathetic nervous activation and failure. Circulation 90:234–240PubMed

34.

Eckberg DL (1997) Sympathovagal balance: a critical appraisal. Circulation 96:3224–3232PubMed

35.

Grassi G, Seravalle G, Quarti-Trevano F et al (2003) Effects of hypertension and obesity on the sympathetic activation of heart failure patients. Hypertension 42:873–877CrossRefPubMed

36.

Folkow B, Di Bona GF, Hjemdahl P et al (1983) Measurements of plasma norepinephrine concentrations in human primary hypertension. Hypertension 5:399–403PubMed

37.

Meredith IT, Eisenhofer G, Lambert GW et al (1992) Plasma norepinephrine responses to head-up tilt are misleading in autonomic failure. Hypertension 19:628–633PubMed

38.

Grassi G, Bolla GB, Seravalle G et al (1997) Comparison between reproducibility and sensitivity of muscle sympathetic nerve traffic and plasma noradrenaline in man. Clin Sci 92:285–289PubMed

39.

Deng XF, Rokosh DG, Simpson PC (2000) Autonomous and growth factor-induced hypertrophy in cultured neonatal mouse cardiac myocytes. Comparison with rat. Circ Res 87:781–788PubMed

40.

Palaniappan L, Carnethon M, Fortmann SP (2003) Association between microalbuminuria and the metabolic syndrome: NHANES III. Am J Hypertens 16:952–958CrossRefPubMed

41.

Cuspidi C, Meani S, Fusi V et al (2004) Metabolic syndrome and target organ damage in untreated essential hypertension. J Hypertens 22:1991–1998CrossRefPubMed

42.

Hoffstedt J, Wahrenberg H, Thorne A, Lonnqvist F (1996) The metabolic syndrome is related to β 3-adrenoceptor sensitivity in visceral adipose tissue. Diabetologia 39:838–844

43.

Grundy SM, Hansen B, Smith SC et al (2004) Clinical management of metabolic syndrome. Report of the American Heart Association/National Heart, Lung and Blood Institute/American Diabetes Association Conference on Scientific issues related to management. Circulation 109:551–556CrossRefPubMed

44.

Grassi G, Seravalle G, Calhoun DA, Mancia G (1994) Physical training and baroreceptor control of sympathetic nerve activity in humans. Hypertension 23:294–301PubMed

Titel: Neuroadrenergic and reflex abnormalities in patients with metabolic syndrome
verfasst von: G. Grassi
R. Dell’Oro
F. Quarti-Trevano
F. Scopelliti
G. Seravalle
F. Paleari
P. L. Gamba
G. Mancia
Publikationsdatum: 01.07.2005
Verlag: Springer-Verlag
Erschienen in: Diabetologia / Ausgabe 7/2005
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-005-1798-z

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