Document Detail

Vascular compression of the rostral ventrolateral medulla in sympathetic mediated essential hypertension.
MedLine Citation:
PMID:  10904016     Owner:  NLM     Status:  MEDLINE    
The pathophysiological factors of neurogenic or sympathetically mediated essential hypertension are unknown. Neurons close to the surface of the ventrolateral medulla (specifically, in the retro-olivary sulcus [ROS]) are integrally involved in the control of blood pressure by means of efferent connections to presympathetic neurons in the spinal cord. It is hypothesized that vascular contact with the ROS is pathogenically involved in neurogenically mediated hypertension. We evaluated that theory in 20 subjects with uncomplicated stage 1 to stage 2 essential hypertension (EHTN) (18 of whom completed the study). The baseline supine plasma norepinephrine level served as an index of central sympathetic outflow. The response of blood pressure to clonidine was used as a surrogate marker for neurogenically mediated hypertension. We also examined the relationship between those markers and evidence of anatomic abnormalities in the area of the ROS that was provided by magnetic resonance imaging. A vessel contacted the left ROS in 5 of the 18 subjects. Those 5 subjects had higher plasma norepinephrine concentrations than did the 13 subjects without this vascular contact (358+/-46 versus 76+/-43 pg/mL, P<0.001). These 5 subjects also exhibited a significant depressor response to clonidine that tended to be greater than that seen in the 13 subjects without vascular contact (-20.6+/-3.2 versus -13.6+/-9 mm Hg). Both race and baseline mean blood pressure had only an independent effect on the depressor response to clonidine. The findings are consistent with the theory that vascular contact with the left ROS may contribute to neurogenically mediated "essential" hypertension in some patients.
D Gajjar; B Egan; J Curè; P Rust; P VanTassel; S J Patel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Hypertension     Volume:  36     ISSN:  0194-911X     ISO Abbreviation:  Hypertension     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-10-06     Completed Date:  2000-10-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  78-82     Citation Subset:  IM    
Department of Neurosurgery, Medical University of South Carolina, Charleston, USA.
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MeSH Terms
Clonidine / pharmacology
Hypertension / etiology*,  physiopathology
Magnetic Resonance Imaging
Medulla Oblongata / physiology*
Middle Aged
Norepinephrine / blood
Sympathetic Nervous System / physiology*
Reg. No./Substance:
4205-90-7/Clonidine; 51-41-2/Norepinephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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