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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

TherapyMechanism of action in PAHDrawbacksRecommendation
Alpha/ Beta blockersReduction in:
- Right ventricular myocardial hypertrophy and fibrosis
-capillary rarefaction
-apoptosis
-inflammation
Reduction in heart rate, cardiac output and exercise capacityPH patients with
comorbidities (arrhythmia, high blood pressure, coronary artery disease, left heart failure)
Renin-angiotensin-aldosterone system inhibitorsReduction in:
-vasoconstriction
-cell proliferation
-extracellular matrix remodeling
-fibrosis
No beneficial effect in some studiesMore clinical data needed
Sympathetic ganglion blockSuppression of activation of the sympathetic nervous system (SNS)-Non-specific
-Invasive
-Not readily reversible
-No clinical data
More data needed
Renal artery denervationSuppression of activation of the SNS and renin-angiotensin-aldosterone system-Non-specific
-Invasive
-Irreversible
-No clinical data in PH
More data needed
Pulmonary artery denervationSuppression of activation of the SNS-Non-specific
-Invasive
-Irreversible
Being tested clinically