Neurohormonal axis in patients with pulmonary arterial hypertension: friend or foe?

Am J Respir Crit Care Med. 2013 Jan 1;187(1):14-9. doi: 10.1164/rccm.201209-1663PP. Epub 2012 Nov 9.


Despite its description some 25 years ago, neurohormonal activation has long been neglected as an important factor in the pathophysiology of pulmonary arterial hypertension (PAH). Neurohormonal activation was interpreted as a necessary compensatory response to maintain cardiac contractility and systemic blood pressure. Therefore, inhibitors of neurohormonal activity (like β-blockers or angiotensin-converting enzyme inhibitors) are considered contraindicated in current PAH management guidelines. However, recent data revealed that sympathetic overstimulation is strongly related to mortality, and blockade of neurohormonal activity in experimental PAH improved survival and cardiac function. These novel insights shed new light on the role of neurohormonal activity in PAH.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / pharmacology
  • Angiotensin II / physiology
  • Heart Atria / physiopathology
  • Heart Atria / surgery
  • Humans
  • Hypertension, Pulmonary / drug therapy
  • Hypertension, Pulmonary / mortality
  • Hypertension, Pulmonary / physiopathology*
  • Hypertension, Pulmonary / surgery
  • Neurotransmitter Agents / physiology*
  • Receptors, Angiotensin / physiology
  • Renin-Angiotensin System / physiology
  • Sympathetic Nervous System / physiopathology


  • Adrenergic beta-Antagonists
  • Neurotransmitter Agents
  • Receptors, Angiotensin
  • Angiotensin II