Specific adrenergic blockers are advocated to counteract sympathetic hyperactivity and slow the progression of renal and cardiac dysfunction in patients with chronic renal failure.
Do specific adrenergic blockers prevent renal and cardiac damage in patients with chronic renal failure?
The review highlights the underutilization of specific adrenergic blockers in chronic renal failure patients and advocates for their increased use to mitigate sympathetic hyperactivity-induced renal and cardiac damage.
Sympathetic hyperactivity plays an important and distinct role in hypertension associated with chronic renal failure (CRF). Renal ischemia, elevated angiotensin II, and suppressed brain nitric oxide (NO) all stimulate sympathetic activity. Evidence is accumulating for a role of sympathetic hyperactivity in renal and cardiac damage in patients with CRF. Decreased NO availability and increased oxidative stress, characteristic in CRF patients, seem to sensitize target organs for damaging actions of sympathetic hyperactivity. Fortunately, sympatholytic agents can slow down progression of renal and cardiac dysfunction. Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists suppress sympathetic activity, but complete elimination of the effect of sympathetic hyperactivity can be obtained only with specific adrenergic blockers. However, this important therapeutic option is grossly neglected, painfully illustrated by the unwillingness to treat CRF patients with beta-blockers, even if they have had a myocardial infarction. After discussion of mechanisms and effects of the sympathetic hyperactivity, a case is made for increased application of specific adrenergic blockers in patients with CRF.
Koomans et al. (Mon,) conducted a review in Chronic Renal Failure. Specific adrenergic blockers was evaluated. Specific adrenergic blockers are advocated to counteract sympathetic hyperactivity and slow the progression of renal and cardiac dysfunction in patients with chronic renal failure.