Neurohormonal Modulation as a Therapeutic Target in Pulmonary Hypertension

Figure 1. Schematic figure summarizing neurohormonal activation in pulmonary hypertension (PH) and pharmacologic and invasive treatments targeting the autonomic nervous system (ANS)/ renin-angiotensin-aldosterone system (RAAS) in this condition. (A) Microphotograph of pulmonary vascular remodeling in experimental pulmonary arterial hypertension (PAH) secondary to systemic-to-pulmonary shunt (in piglets). Black arrows point to a plexiform lesion, one of the histopathological hallmarks of pulmonary arterial hypertension (PAH); (B–D). Figures of parasternal long-axis transthoracic echocardiograms illustrating the spectrum of patients with PH secondary to heart failure (HF). (B) A patient with HF with reduced ejection fraction (secondary to dilated cardiomyopathy): (C) HF with preserved ejection fraction (secondary to hypertrophic cardiomyopathy); and (D) HF secondary to valvular heart disease (severe aortic regurgitation). ACE-I, angiotensin-converting enzyme inhibitors; ACE2+, angiotensin-converting enzyme stimulator; AR, adrenergic receptor; ARB, angiotensin receptor blocker; βB, beta-blocker; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection…