Sympathoadrenal Activity, Catecholamines, and the Pathogenesis of Vasculopathic Hypertensive Target-Organ Damage

In addition to the heart, the kidneys, eyes, and brain are the target organs of concern in people with hypertension. This review examines the evidence that damage to these organs can be grouped under the basic heading of hypertensive vasculopathy. The pathogenesis of hypertensive vasculopathy is incompletely understood, but probably involves both mechanical and humoral factors. The sympathoadrenal system and catecholamines have several potentially deleterious effects on large and small blood vessels and may promote thrombotic events. The hypothesis is put forward that norepinephrine is a major contributor to hypertensive vasculopathy and an overlooked cardiovascular risk factor. Choosing the optimal antihypertensive drugs may require considering the impact of the drugs on the sympathoadrenal system.