Abstract
Stress in several guises is evident in individuals with hypertension and in those with the metabolic syndrome and may account, at least in part, for the extent and pattern of sympathetic nervous activation. Importantly, elevated activity of the sympathetic nervous system is related to the development of obesity-related illnesses including hypertension, insulin resistance, and renal, cardiac, and vascular impairment. Notably, evidence of subclinical organ damage is evident even in young, normotensive, overweight persons, thereby reinforcing the need to develop and implement effective early intervention.
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Anagnostis P, Athyros VG, Tziomalos K, et al. Clinical review: the pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metab. 2009;94:2692–701.
Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51:1237–46.
Esler M, Eikelis N, Schlaich M, et al. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clin Exp Pharmacol Physiol. 2008;35:498–502.
Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. BMJ. 2006;332:521–5.
Esler M, Jennings G, Lambert G. Measurement of overall and cardiac norepinephrine release into plasma during cognitive challenge. Psychoneuroendocrinology. 1989;14:477–81.
Grassi G, Seravalle G, Dell’Oro R, et al. Adrenergic and reflex abnormalities in obesity-related hypertension. Hypertension. 2000;36:538–42.
Lambert E, Straznicky N, Eikelis N, et al. Gender differences in sympathetic nervous activity: influence of body mass and blood pressure. J Hypertens. 2007;25:1411–9.
•• Lambert E, Sari CI, Dawood T, et al. Sympathetic nervous system activity is associated with obesity-induced subclinical organ damage in young adults. Hypertension. 2010;56:351–8. This article documents the association between sympathetic nervous activation and preclinical signs of end-organ damage in young, overweight, yet normotensive individuals, thereby highlighting the need for early detection and possible intervention.
Rumantir MS, Jennings GL, Lambert GW, et al. The ‘adrenaline hypothesis’ of hypertension revisited: evidence for adrenaline release from the heart of patients with essential hypertension. J Hypertens. 2000;18:717–23.
Micutkova L, Krepsova K, Sabban E, et al. Modulation of catecholamine-synthesizing enzymes in the rat heart by repeated immobilization stress. Ann NY Acad Sci. 2004;1018:424–9.
Wallin BG, Esler M, Dorward P, et al. Simultaneous measurements of cardiac noradrenaline spillover and sympathetic outflow to skeletal muscle in humans. J Physiol. 1992;453:45–58.
Lucini D, Di Fede G, Parati G, Pagani M. Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension. 2005;46:1201–6.
• Flaa A, Aksnes TA, Kjeldsen SE, et al. Increased sympathetic reactivity may predict insulin resistance: an 18-year follow-up study. Metabolism. 2008;57:1422–7. Sympathetic reactivity was shown to be predictive of subsequent development of insulin resistance.
Marmot MG, Bosma H, Hemingway H, et al. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997;350:235–9.
Rosengren A, Hawken S, Ounpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953–62.
Bjorntorp P. Neuroendocrine abnormalities in human obesity. Metabolism. 1995;44:38–41.
Vicennati V, Pasqui F, Cavazza C, et al. Stress-related development of obesity and cortisol in women. Obesity (Silver Spring). 2009;17:1678–83.
Zhang J, Niaura R, Dyer JR, et al. Hostility and urine norepinephrine interact to predict insulin resistance: the VA normative aging study. Psychosom Med. 2006;68:718–26.
Fowler-Brown AG, Bennett GG, Goodman MS, et al. Psychosocial stress and 13-year BMI change among blacks: the Pitt county study. Obesity (Silver Spring). 2009;17:2106–9.
Block JP, He Y, Zaslavsky AM, et al. Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009;170:181–92.
van Jaarsveld CH, Fidler JA, Steptoe A, et al. Perceived stress and weight gain in adolescence: a longitudinal analysis. Obesity (Silver Spring). 2009;17:2155–61.
Zhao G, Ford ES, Dhingra S, et al. Depression and anxiety among US adults: associations with body mass index. Int J Obes (Lond). 2009;33:257–66.
Kopf D, Westphal S, Luley CW, et al. Lipid metabolism and insulin resistance in depressed patients: significance of weight, hypercortisolism, and antidepressant treatment. J Clin Psychopharmacol. 2004;24:527–31.
Ljung T, Ahlberg AC, Holm G, et al. Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study. J Intern Med. 2001;250:219–24.
Barton DA, Dawood T, Lambert EA, et al. Sympathetic activity in major depressive disorder: identifying those at increased cardiac risk? J Hypertens. 2007;25:2117–24.
Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–9.
Vogelzangs N, Suthers K, Ferrucci L, et al. Hypercortisolemic depression is associated with the metabolic syndrome in late-life. Psychoneuroendocrinology. 2007;32:151–9.
Vogelzangs N, Kritchevsky SB, Beekman AT, et al. Depressive symptoms and change in abdominal obesity in older persons. Arch Gen Psychiatry. 2008;65:1386–93.
Skilton MR, Moulin P, Terra JL, Bonnet F. Associations between anxiety, depression, and the metabolic syndrome. Biol Psychiatry. 2007;62:1251–7.
Lambert GW, Straznicky NE, Lambert EA, et al. Sympathetic nervous activation in obesity and the metabolic syndrome-causes, consequences and therapeutic implications. Pharmacol Ther. 2010;126:159–72.
Kuo LE, Kitlinska JB, Tilan JU, et al. Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome. Nat Med. 2007;13:803–11.
Morris MJ, Cox HS, Lambert GW, et al. Region-specific neuropeptide Y overflows at rest and during sympathetic activation in humans. Hypertension. 1997;29:137–43.
Grassi G, Seravalle G, Cattaneo BM, et al. Sympathetic activation in obese normotensive subjects. Hypertension. 1995;25:560–3.
Straznicky NE, Lambert EA, Lambert GW, et al. Effects of dietary weight loss on sympathetic activity and cardiac risk factors associated with the metabolic syndrome. J Clin Endocrinol Metab. 2005;90:5998–6005.
Straznicky NE, Eikelis N, Lambert EA, Esler MD. Mediators of sympathetic activation in metabolic syndrome obesity. Curr Hypertens Rep. 2008;10:440–7.
Lambert E, Straznicky N, Schlaich M, et al. Differing pattern of sympathoexcitation in normal-weight and obesity-related hypertension. Hypertension. 2007;50:862–8.
Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation. 2002;106:2533–6.
Straznicky NE, Grima MT, Eikelis N, et al: The effects of weight loss versus weight loss maintenance on sympathetic nervous system activity and metabolic syndrome components. J Clin Endocrinol Metab 2010 Dec 22 (Epub ahead of print).
Mathieu P, Poirier P, Pibarot P, et al. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009;53:577–84.
Grassi G. Sympathetic overdrive and cardiovascular risk in the metabolic syndrome. Hypertens Res. 2006;29:839–47.
Wirtz PH, Ehlert U, Bartschi C, et al. Changes in plasma lipids with psychosocial stress are related to hypertension status and the norepinephrine stress response. Metabolism. 2009;58:30–7.
•• Lambert E, Dawood T, Straznicky N, et al. Association between the sympathetic firing pattern and anxiety level in patients with the metabolic syndrome and elevated blood pressure. J Hypertens. 2010;28:543–50. This paper highlights the importance of psychosocial stress in influencing the pattern of sympathetic nerve firing.
Lambert E, Hotchkin E, Alvarenga M, et al. Single-unit analysis of sympathetic nervous discharges in patients with panic disorder. J Physiol. 2006;570:637–43.
Lambert E, Dawood T, Schlaich M, et al. Single-unit sympathetic discharge pattern in pathological conditions associated with elevated cardiovascular risk. Clin Exp Pharmacol Physiol. 2008;35:503–7.
Macefield VG, Rundqvist B, Sverrisdottir YB, et al. Firing properties of single muscle vasoconstrictor neurons in the sympathoexcitation associated with congestive heart failure. Circulation. 1999;100:1708–13.
Shibao C, Gamboa A, Diedrich A, et al. Autonomic contribution to blood pressure and metabolism in obesity. Hypertension. 2007;49:27–33.
Rumantir MS, Vaz M, Jennings GL, et al. Neural mechanisms in human obesity-related hypertension. J Hypertens. 1999;17:1125–33.
Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361:932–4.
Straznicky NE, Lambert EA, Nestel PJ, et al. Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Diabetes. 2010;59:71–9.
Acknowledgment
This work was supported by grants from the National Health and Medical Research Council of Australia (NHMRC).
Disclosure
The investigators (or their laboratory) have received research funding from commercial sponsors including Abbot (formerly Solvay Pharmaceuticals), Servier, Ardian Inc, Allergan, and Scientific Intake. Dr. Gavin Lambert has received honoraria or travel support for presentations from Servier, Wyeth Pharmaceuticals, and Pfizer. No other potential conflicts of interest relevant to this article were reported.
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Lambert, E.A., Lambert, G.W. Stress and Its Role in Sympathetic Nervous System Activation in Hypertension and the Metabolic Syndrome. Curr Hypertens Rep 13, 244–248 (2011). https://doi.org/10.1007/s11906-011-0186-y
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DOI: https://doi.org/10.1007/s11906-011-0186-y