Table 1 Pharmacological and invasive therapies targeting the autonomic nervous system in pulmonary arterial hypertension
From: Pulmonary arterial hypertension: the case for a bioelectronic treatment
Therapy | Mechanism of action in PAH | Drawbacks | Recommendation |
|---|---|---|---|
Alpha/ Beta blockers | Reduction in: - Right ventricular myocardial hypertrophy and fibrosis -capillary rarefaction -apoptosis -inflammation | Reduction in heart rate, cardiac output and exercise capacity | PH patients with comorbidities (arrhythmia, high blood pressure, coronary artery disease, left heart failure) |
Renin-angiotensin-aldosterone system inhibitors | Reduction in: -vasoconstriction -cell proliferation -extracellular matrix remodeling -fibrosis | No beneficial effect in some studies | More clinical data needed |
Sympathetic ganglion block | Suppression of activation of the sympathetic nervous system (SNS) | -Non-specific -Invasive -Not readily reversible -No clinical data | More data needed |
Renal artery denervation | Suppression of activation of the SNS and renin-angiotensin-aldosterone system | -Non-specific -Invasive -Irreversible -No clinical data in PH | More data needed |
Pulmonary artery denervation | Suppression of activation of the SNS | -Non-specific -Invasive -Irreversible | Being tested clinically |