Pharmacologic modulation of parasympathetic activity in heart failure

Heart Failure Reviews
Monali Y DesaiPaul J Hauptman

Abstract

In the congestive heart failure state, autonomic dysregulation involves an increase in sympathetic tone and decrease in parasympathetic tone and is associated with increased mortality. It is possible that augmentation of the parasympathetic nervous system (PNS) with pharmacologic therapy may lead to improved symptoms and/or clinical outcomes. There are several new and established pharmacologic interventions that have been studied for their effect on the PNS, including antagonists of the renin-angiotensin system, beta-adrenergic antagonists, digoxin, and vasodilators. In this review, we discuss the current status of the published literature on pharmacologic influences on the PNS by both conventional and experimental drugs targeting heart failure as well as drugs that more directly influence vagal tone. While these analyses have been largely limited to putative surrogates for clinical outcomes like heart rate variability, and it is often difficult to differentiate between indirect and direct pharmacologic effects on the PNS, significant insight into potential mechanisms of action can be derived. The future evaluation of drugs in development for heart failure treatment should include a careful, scientifically sound exploration of ...Continue Reading

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Citations

Dec 18, 2010·Heart Failure Reviews·Gaetano M De Ferrari, Peter J Schwartz
Dec 31, 2010·Heart Failure Reviews·Paul J Hauptman, Douglas L Mann
Feb 6, 2016·Current Hypertension Reports·Jhansi DyavanapalliDavid Mendelowitz
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Sep 19, 2015·Current Cardiology Reports·Mark E DunlapPaul J Hauptman
Jun 20, 2012·American Heart Journal·Paul J HauptmanDouglas L Mann
Apr 9, 2016·Journal of the American College of Cardiology·Michael R GoldDouglas L Mann
Jan 18, 2018·Journal of the American Heart Association·Dongze ZhangYu-Long Li
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Mar 29, 2012·Menopause : the Journal of the North American Menopause Society·Eiran Z Gorodeski
Feb 27, 2021·Clinical Science·Catherine F Notarius, John S Floras
Sep 7, 2021·Physiology·Matthew W KayDavid Mendelowitz

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