cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2020-2693cardiovascular-2693Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMГиперсимпатикотония в патогенезе артериальной гипертонии и методы ее коррекции. Часть ISympathetic hyperactivity in patients with hypertension: pathogenesis and treatment. Part Ihttps://orcid.org/0000-0002-6104-8388СафарянА. С.SafaryanA. S.anush70@list.ruhttps://orcid.org/0000-0003-3793-7369СаргсянВ. Д.SargsyanV. D.

Вардуи Саргсян — кандидат медицинских наук, старший научный сотрудник отдела профилактики метаболических нарушений

VSargsyan@gnicpm.ruФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава РоссииNational Research Center for Therapy and Preventive Medicine20202910202019626932693Copyright © Сафарян А.С., Саргсян В.Д., 20202020Сафарян А.С., Саргсян В.Д.Safaryan A.S., Sargsyan V.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2693

Статья посвящена  изучению влияния симпатической нервной системы (СНС) на сердечно-сосудистую  систему. Рассматриваются вопросы  влияния  активности  CНC на  уровень  артериального  давления  и  патогенез  развития  артериальной   гипертонии, а также воздействие CНC на многие биохимические,  обменные и метаболические  процессы,  играющие  ключевую роль  в развитии метаболического  синдрома  и артериальной  гипертонии. Рассматриваются  возможные механизмы воздействия  различных методов (хирургических, немедикаментозных),  снижающих активность CНC, восстанавливающих работу вегетативной нервной системы и, соответственно, нормализующих состояние сердечно-сосудистой системы и показатели артериального давления. 

The article is devoted to the influence of sympathetic  nervous system (SNS) on the cardiovascular  system.  Influence of SNS activity on the blood pressure  level and the pathogenesis of hypertension  development, as well as the effect of SNS on many biochemical and metabolic parameters playing a key role in the development  of metabolic syndrome and hypertension  are considered. Possible mechanisms  of action of various methods that reduce  the SNS activity, restore  the function of autonomic nervous system  and normalize the cardiovascular system and blood pressure  are considered.

артериальная гипертонияремоделированиевегетативная нервная системасимпатическая нервная системасердечно-сосудистая системахирургические и немедикаментозные воздействия.hypertensionremodelingautonomic Sargsyan nervous systemsympathetic nervous systemcardiovascular systemsurgical and nondrug effectsReferencesКушаковский М. С. Эссенциальная гипертензия (гипертоническая болезнь). Причины, механизмы, клиника, лечение. СПб., Издательство Фолиант, 2002. 414 с. 5 изд., существенно доп. и перераб. ISBN:5-93929-045-0.Kushakovsky MS. Essential hypertension (hypertension). The causes, mechanisms, clinical features, treatment. Foliant publishing house, 2002. 414 p. 5 publication, significantly expanded and revised. (In Russ.)Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res. 2014;114(11):1804-14. doi:10.1161/CIRCRESAHA.114.302524.Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res. 2014;114(11):1804-14. doi:10.1161/CIRCRESAHA.114.302524.Grassi G, Mark A, Esler M. The sympathetic nervous system alterations in human hypertension. Circ Res. 2015;116(6):976-90. doi:10.1161/CIRCRESAHA.116.303604.Grassi G, Mark A, Esler M. The sympathetic nervous system alterations in human hypertension. Circ Res. 2015;116(6):976-90. doi:10.1161/CIRCRESAHA.116.303604.Практическое руководство по детским болезням под общей ред. В. Ф. Коколиной и А. Г. Румянцева. Детская вегетология: прак-тическое руководство по детским болезням. М.: ИД Мед. прак-тика, 2008. XI т. глава 2 с. 22-32. ISBN:978-5-98803-125-3.Practical guide to children’s diseases under the General editorship of V. F. Kokolina VF and Rumyantsev AG. Children’s vegetology: a practical guide to children’s diseases. Med. Praktika publishing house, 2008. XI vol. Chapter 2 p. 22-32. (In Russ.)Вегетативные расстройства: Клиника, лечение, диагностика. Под ред. А. М. Вейна. М.: Медицинское информационное агентство, 2000. 752 с. ISBN 5-89481-066-3.Vegetative disorders: Clinic, treatment, diagnosis. Ed. by A. M. Wein. M.: Medical information Agency, 2000. 752 p. (In Russ.)Grassi G, Seravalle G, Brambilla G, et al. Marked sympathetic activation and baroreflex dysfunction in true resistant hypertension. Int J Cardiol. 2014;177(3):1020-5. doi:10.1016/j.ijcard.2014.09.138.Grassi G, Seravalle G, Brambilla G, et al. Marked sympathetic activation and baroreflex dysfunction in true resistant hypertension. Int J Cardiol. 2014;177(3):1020-5. doi:10.1016/j.ijcard.2014.09.138.Grassi G, Colombo M, Seravalle G, et al. Dissociation between muscle and skin sympathetic nerve activity in essential hypertension, obesity, and congestive heart failure. Hypertension. 1998;31(1):64-7. doi:10.1161/01.hyp.31.1.64.Grassi G, Colombo M, Seravalle G, et al. Dissociation between muscle and skin sympathetic nerve activity in essential hypertension, obesity, and congestive heart failure. Hypertension. 1998;31(1):64-7. doi:10.1161/01.hyp.31.1.64.Burns J, Sivananthan ML, Ball SG, et al. Relationship between central sympathetic drive and magnetic resonance determined left ventricular mass in essential hypertension. Circulation. 2007;115(15):1999-2005. doi:10.1161/CIRCULATIONAHA.106.668863.Burns J, Sivananthan ML, Ball SG, et al. Relationship between central sympathetic drive and magnetic resonance determined left ventricular mass in essential hypertension. Circulation. 2007;115(15):1999-2005. doi:10.1161/CIRCULATIONAHA.106.668863.Grassi G, Seravalle G, Quarti-Trevano F, et al. Sympathetic and baroreflex cardiovascular control in hypertension-related left ventricualr diastolic dysfunction. Hypertension. 2009;53(2):205-9. doi:10.1161/HYPERTENSIONAHA.108.121467.Grassi G, Seravalle G, Quarti-Trevano F, et al. Sympathetic and baroreflex cardiovascular control in hypertension-related left ventricualr diastolic dysfunction. Hypertension. 2009;53(2):205-9. doi:10.1161/HYPERTENSIONAHA.108.121467.Heagerty AM, Withers SB, Izzard AS, Greenstein AS, Aghamohammadzadeh R. Small artery structure and function in hypertension /Mancia G, Grassi G, Redon J. (eds). Manual of Hypertension of the European Society of Hypertension. CRC Press (London). 2014;203-10. doi:10.1201/b17072-21.Heagerty AM, Withers SB, Izzard AS, Greenstein AS, Aghamohammadzadeh R. Small artery structure and function in hypertension /Mancia G, Grassi G, Redon J. (eds). Manual of Hypertension of the European Society of Hypertension. CRC Press (London). 2014;203-10. doi:10.1201/b17072-21.Grassi G, Quarti-Trevano F, Seravalle G, et al. Early sympathetic activation in the initial clinical stages of chronic renal failure. Hypertension. 2011;57(4):846-51. doi:10.1161/HYPERTENSIONAHA.110.164780.Grassi G, Quarti-Trevano F, Seravalle G, et al. Early sympathetic activation in the initial clinical stages of chronic renal failure. Hypertension. 2011;57(4):846-51. doi:10.1161/HYPERTENSIONAHA.110.164780.Strand AH, Gudmundsdottir H, Os I, et al. Arterial plasma noradrenaline predicts left ventricular mass independently of blood pressure and body build in men who develop hypertension over 20 years. J Hypertens. 2006;24(5):905-13. doi:10.1097/01.hjh.0000222761.07477.7b.Strand AH, Gudmundsdottir H, Os I, et al. Arterial plasma noradrenaline predicts left ventricular mass independently of blood pressure and body build in men who develop hypertension over 20 years. J Hypertens. 2006;24(5):905-13. doi:10.1097/01.hjh.0000222761.07477.7b.Weber KT, Brilla CG, Janicki JS. Myocardial fibrosis: functional significance and regulatory factors. Cardiovasc Res. 1993;27(3):341-8. doi:10.1093/cvr/27.3.341.Weber KT, Brilla CG, Janicki JS. Myocardial fibrosis: functional significance and regulatory factors. Cardiovasc Res. 1993;27(3):341-8. doi:10.1093/cvr/27.3.341.Díez M. Mechanisms of cardiac fibrosis in hypertension. J Clin Hypertens. 2007;9(7):546-50. doi:10.1111/j.1524-6175.2007.06626.x.Díez M. Mechanisms of cardiac fibrosis in hypertension. J Clin Hypertens. 2007;9(7):546-50. doi:10.1111/j.1524-6175.2007.06626.x.Maceira AM, Mohiaddin RH. Cardiovascular magnetic resonance in systemic hypertension. J Cardiovasc Magn Reson. 2012;14(1):28. doi:10.1186/1532-429X-14-28.Maceira AM, Mohiaddin RH. Cardiovascular magnetic resonance in systemic hypertension. J Cardiovasc Magn Reson. 2012;14(1):28. doi:10.1186/1532-429X-14-28.Mancia G, Grassi G, Giannattasio C, et al. Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. Hypertension. 1999;34(4 Pt 2):724-8. doi:10.1161/01.hyp.34.4.724.Mancia G, Grassi G, Giannattasio C, et al. Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. Hypertension. 1999;34(4 Pt 2):724-8. doi:10.1161/01.hyp.34.4.724.DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev. 1997;77(1):75-197. doi: 10.1152/physrev.1997.77.1.75.DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev. 1997;77(1):75-197. doi: 10.1152/physrev.1997.77.1.75.Vaz M, Jennings G, Turner A, et al. Regional sympathetic nervous activity and oxygen consumption in obese normotensive human subjects. Circulation. 1997;96(10):3423-9. doi:10.1161/01.cir.96.10.3423.Vaz M, Jennings G, Turner A, et al. Regional sympathetic nervous activity and oxygen consumption in obese normotensive human subjects. Circulation. 1997;96(10):3423-9. doi:10.1161/01.cir.96.10.3423.Zubcevic J, Waki H, Raizada MK, et al. Autonomic-Im- mune-Vascular Interaction: An Emerging Concept for Neurogenic. Hypertension. 2011;57(6):1026-33. doi:10.1161/HYPERTENSIONAHA.111.169748.Zubcevic J, Waki H, Raizada MK, et al. Autonomic-Im- mune-Vascular Interaction: An Emerging Concept for Neurogenic. Hypertension. 2011;57(6):1026-33. doi:10.1161/HYPERTENSIONAHA.111.169748.Rodriguez-Iturbe B, Pons H, Johnson RJ. Role of immune system in hypertension. Physiol Rev 2017;97(3):1127-1164. doi:10.1152/physrev.00031.2016.Rodriguez-Iturbe B, Pons H, Johnson RJ. Role of immune system in hypertension. Physiol Rev 2017;97(3):1127-1164. doi:10.1152/physrev.00031.2016.Carnagarin R, Matthews V, Zaldivia MT, et al. The bidirectional interaction between the sympathetic nervous system and immune mechanisms in the pathogenesis of hypertension. Br J Pharmacol. 2019;176(12):1839-52. doi:10.1111/bph.14481.Carnagarin R, Matthews V, Zaldivia MT, et al. The bidirectional interaction between the sympathetic nervous system and immune mechanisms in the pathogenesis of hypertension. Br J Pharmacol. 2019;176(12):1839-52. doi:10.1111/bph.14481.Page IH, Heuer GJ. A surgical treatment of essential hyperten- sion. J Clin Invest. 1935;14(1):22-6. doi:10.1172/JCI100651.Page IH, Heuer GJ. A surgical treatment of essential hyperten- sion. J Clin Invest. 1935;14(1):22-6. doi:10.1172/JCI100651.Allen EV. Sympathectomy for essential hypertension. Circulation. 1952;6(1):131-40. doi:10.1161/01.cir.6.1.131.Allen EV. Sympathectomy for essential hypertension. Circulation. 1952;6(1):131-40. doi:10.1161/01.cir.6.1.131.Simplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, et al. Renal sympathetic denervation in patients with treatment resistant hypertension (The Simplicity THN-2 trial): a randomised control trial. Lancet. 2010;376(9756):1903-9. doi:10.1016/S0140-6736(10)62039-9.Simplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, et al. Renal sympathetic denervation in patients with treatment resistant hypertension (The Simplicity THN-2 trial): a randomised control trial. Lancet. 2010;376(9756):1903-9. doi:10.1016/S0140-6736(10)62039-9.Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361(9):932-4. doi:10.1056/NEJMc0904179.Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361(9):932-4. doi:10.1056/NEJMc0904179.Cowley Jr. AW, Liard JF, Guyton AC. Role of baroreceptor reflex in daily control of arterial blood pressure and other variables in dogs. Circulation Research. 1973;32(5):564-76. doi:10.1161/01.res.32.5.564.Cowley Jr. AW, Liard JF, Guyton AC. Role of baroreceptor reflex in daily control of arterial blood pressure and other variables in dogs. Circulation Research. 1973;32(5):564-76. doi:10.1161/01.res.32.5.564.Bilgutay AM, Lillehei CW. Surgical treatment of hypertension with reference to baropacing. Am J Cardiol. 1966;17:663-7. doi:10.1016/0002-9149(66)90404-8.Bilgutay AM, Lillehei CW. Surgical treatment of hypertension with reference to baropacing. Am J Cardiol. 1966;17:663-7. doi:10.1016/0002-9149(66)90404-8.Grassi G. Sympathetic deactivation as a goal of nonpharma-cologic and pharmacologic antihypertensive treatment: rationa- le and options. Curr Hypertens Rep. 2003;5:277-80. doi:10.1007/s11906-003-0033-x.Grassi G. Sympathetic deactivation as a goal of nonpharma-cologic and pharmacologic antihypertensive treatment: rationa- le and options. Curr Hypertens Rep. 2003;5:277-80. doi:10.1007/s11906-003-0033-x.Sanchez LA, Illig K, Levy M, et al. Implantable carotid sinus stimulator for the treatment of resistant hypertension: local effects on carotid artery morphology. Ann Vasc Surg. 2010;24(2):178-84. doi:10.1016/j.avsg.2009.10.003.Sanchez LA, Illig K, Levy M, et al. Implantable carotid sinus stimulator for the treatment of resistant hypertension: local effects on carotid artery morphology. Ann Vasc Surg. 2010;24(2):178-84. doi:10.1016/j.avsg.2009.10.003.Lovett EG, Shaefer J, Kaifman CL. Chronic baroreflex activation by the Rheos system: an overview of results from European and North American feasibility studies. Annu Int Conf IEEE Eng Med Biol Soc. 2009;2009:4626-30. doi:10.1109/IEMBS.2009.5332680.Lovett EG, Shaefer J, Kaifman CL. Chronic baroreflex activation by the Rheos system: an overview of results from European and North American feasibility studies. Annu Int Conf IEEE Eng Med Biol Soc. 2009;2009:4626-30. doi:10.1109/IEMBS.2009.5332680.Spiering W, Williams B, Van der Heyden J, et al. Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study. Lancet. 2017;390(10113):2655-2661. doi:10.1016/S0140-6736(17)32337-1.Spiering W, Williams B, Van der Heyden J, et al. Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study. Lancet. 2017;390(10113):2655-2661. doi:10.1016/S0140-6736(17)32337-1.Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281-357. doi:10.1097/01.hjh.0000431740.32696.cc.Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281-357. doi:10.1097/01.hjh.0000431740.32696.cc.Landsberg L, Young JB. Fasting, feeding, and the regulation of the sympathetic nervous system. N Engl J Med. 1978;298:1295-301. doi:10.1056/NEJM197806082982306.Landsberg L, Young JB. Fasting, feeding, and the regulation of the sympathetic nervous system. N Engl J Med. 1978;298:1295-301. doi:10.1056/NEJM197806082982306.Verwaerde P, Senard JM, Galiener M, et al. Changes in short-term variability of blood pressure and heart rate during the development of obesity-associated hypertension in high-fat fed dogs. J Hypertension. 1999;17(8):1135-43. doi:10.1097/00004872-199917080-00013.Verwaerde P, Senard JM, Galiener M, et al. Changes in short-term variability of blood pressure and heart rate during the development of obesity-associated hypertension in high-fat fed dogs. J Hypertension. 1999;17(8):1135-43. doi:10.1097/00004872-199917080-00013.O’Dea K, Esler M, Leonard P, et al. Noradrenaline turnover during under- and over-eating in normal weight subjects. Metabolism. 1982;31(9):896-9. doi:10.1016/0026-0495(82)90178-0.O’Dea K, Esler M, Leonard P, et al. Noradrenaline turnover during under- and over-eating in normal weight subjects. Metabolism. 1982;31(9):896-9. doi:10.1016/0026-0495(82)90178-0.Tentolouris N, Liatis S, Katsilambros N. Sympathetic system activity in obesity and metabolic syndrome. Ann N Y Acad Sci. 2006;1083:129-52. doi:10.1196/annals.1367.010.Tentolouris N, Liatis S, Katsilambros N. Sympathetic system activity in obesity and metabolic syndrome. Ann N Y Acad Sci. 2006;1083:129-52. doi:10.1196/annals.1367.010.Landsberg L, Troisi R, Parker D, et al. Obesity, blood pressure, and the sympathetic nervous system. Ann Epidemiol. 1991;1(4):295-303. doi:10.1016/1047-2797(91)90040-j.Landsberg L, Troisi R, Parker D, et al. Obesity, blood pressure, and the sympathetic nervous system. Ann Epidemiol. 1991;1(4):295-303. doi:10.1016/1047-2797(91)90040-j.Cfmplifield DА, Smith FJ, Guisez Y, et al. Recombinant mouse OB protein: evidence for a peripheral signal linking adipo sity and central neural networks. Science. 1995;269(5223):546-9. doi:10.1126/science.7624778.Cfmplifield DА, Smith FJ, Guisez Y, et al. Recombinant mouse OB protein: evidence for a peripheral signal linking adipo sity and central neural networks. Science. 1995;269(5223):546-9. doi:10.1126/science.7624778.Caro JF, Sinha MK, Kolaczynski JW, et al. Leptin: the tale of an obesity gene. Diabetes. 1996;45(11):1455-62. doi:10.2337/di-ab.45.11.1455.Caro JF, Sinha MK, Kolaczynski JW, et al. Leptin: the tale of an obesity gene. Diabetes. 1996;45(11):1455-62. doi:10.2337/di-ab.45.11.1455.Dunbar JC, Hu Y, Lu H. Intracerebroventricular leptin increases lumbal and renal sympathetic nerve activity and blood pressure in normal rats. Diabetes. 1997;46:2040-3. doi:10.2337/di-ab.46.12.2040.Dunbar JC, Hu Y, Lu H. Intracerebroventricular leptin increases lumbal and renal sympathetic nerve activity and blood pressure in normal rats. Diabetes. 1997;46:2040-3. doi:10.2337/di-ab.46.12.2040.Paolisso G, Manzella D, Montano N, et al. Plasma leptin concentrations and cardiac autonomic nervous system in healthy subjects with different body weights. J Clin Endocrinol. 2000;85:1810-4. doi:10.1210/jcem.85.5.6511.Paolisso G, Manzella D, Montano N, et al. Plasma leptin concentrations and cardiac autonomic nervous system in healthy subjects with different body weights. J Clin Endocrinol. 2000;85:1810-4. doi:10.1210/jcem.85.5.6511.Haynes WG, Sivitz WI, Morgan DA, et al. Sympathetic and cardiac actions of leptin. Hypertension.1997;30:619-23. doi:10.1161/01.hyp.30.3.619.Haynes WG, Sivitz WI, Morgan DA, et al. Sympathetic and cardiac actions of leptin. Hypertension.1997;30:619-23. doi:10.1161/01.hyp.30.3.619.Balasubramanian P, Hall D, Subramanian M. Sympathetic nervous system as a target for aging and obesity-related cardiovascular diseases. Geroscience. 2019;41(1):13-24. doi:10.1007/s11357-018-0048-5.Balasubramanian P, Hall D, Subramanian M. Sympathetic nervous system as a target for aging and obesity-related cardiovascular diseases. Geroscience. 2019;41(1):13-24. doi:10.1007/s11357-018-0048-5.Landsberg L. Hyperinsulinemia: possible role in obesity-induced hypertension. Hypertension. 1992;19(1 Suppl):I61-6. doi:10.1161/01.hyp.19.1_suppl.i61.Landsberg L. Hyperinsulinemia: possible role in obesity-induced hypertension. Hypertension. 1992;19(1 Suppl):I61-6. doi:10.1161/01.hyp.19.1_suppl.i61.Baskin DG, Figlewicz DP, Woods SC, et al. Insulin in the brain. Ann Rev Physiol. 1987;49:335-47. doi:10.1146/annurev.ph.49.030187.002003.Baskin DG, Figlewicz DP, Woods SC, et al. Insulin in the brain. Ann Rev Physiol. 1987;49:335-47. doi:10.1146/annurev.ph.49.030187.002003.O’Hare JA, Minaker KL, Meneilly GS, et al. Effect of insulin on plasma norepinephrine and 3,4-dihydroxyphenylalanine in obese men. Metabolism, 1989;38:322-29. doi:10.1016/0026-0495(89)90118-2.O’Hare JA, Minaker KL, Meneilly GS, et al. Effect of insulin on plasma norepinephrine and 3,4-dihydroxyphenylalanine in obese men. Metabolism, 1989;38:322-29. doi:10.1016/0026-0495(89)90118-2.Carretta R, Fabris B, Fischetti F, et al. Reduction of blood pressure in obese hyperinsulinemic hypertensive patients during somatostatin infusion. J Hypertens. 1989;7(6):S196-7. doi:10.1097/00004872-198900076-00094.Carretta R, Fabris B, Fischetti F, et al. Reduction of blood pressure in obese hyperinsulinemic hypertensive patients during somatostatin infusion. J Hypertens. 1989;7(6):S196-7. doi:10.1097/00004872-198900076-00094.Дедов И. И., Мельниченко Г. А., Шестакова М. В., и соавт. Национальные клинические рекомендации по лечению морбидного ожирения у взрослых. 3-ий пересмотр (Лечение морбидного ожирения у взрослых). Ожирение и метаболизм. 2018;15(1):53-70. doi:10.14341/OMET2018153-70.Dedov II, Melnichenko GA, Shestakova MV, et al. Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults). Obesity and metabolism. 2018;15(1):53-70. (In Russ.) doi:10.14341/OMET2018153-70.Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473. doi:10.1161/JAHA.112.004473.Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473. doi:10.1161/JAHA.112.004473.Rossi A, Dikareva A, Bacon SL, Daskalopoulou SS. The impact of physical activity on mortality in patients with high blood pressure: a systematic review. J Hypertens. 2012;30(7):1277-88. doi:10.1097/HJH.0b013e3283544669.Rossi A, Dikareva A, Bacon SL, Daskalopoulou SS. The impact of physical activity on mortality in patients with high blood pressure: a systematic review. J Hypertens. 2012;30(7):1277-88. doi:10.1097/HJH.0b013e3283544669.Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339.Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339.Markil N, Whitehurst M, Jacobs PL, Zoeller RF. Yoga Nidra relaxation increases heart rate variability and is unaffected by a prior bout of Hatha yoga. J Altern Complement Med. 2012;18(10):953-8. doi:10.1089/acm.2011.0331.Markil N, Whitehurst M, Jacobs PL, Zoeller RF. Yoga Nidra relaxation increases heart rate variability and is unaffected by a prior bout of Hatha yoga. J Altern Complement Med. 2012;18(10):953-8. doi:10.1089/acm.2011.0331.Adhana R, Gupta R, Dvivedii J, Ahmad S. The influence of the 2:1 yogic breathing technique on essential hypertension. Indian J Physiol Pharmacol. 2013;57(1):38-44.Adhana R, Gupta R, Dvivedii J, Ahmad S. The influence of the 2:1 yogic breathing technique on essential hypertension. Indian J Physiol Pharmacol. 2013;57(1):38-44.Bharshankar JR, Mandape AD, Phatak SM, Bharshankar RN. Autonomic Functions In Raja-yoga Meditators. Indian J Physiol Pharmacol. 2015;59(4):396-401.Bharshankar JR, Mandape AD, Phatak SM, Bharshankar RN. Autonomic Functions In Raja-yoga Meditators. Indian J Physiol Pharmacol. 2015;59(4):396-401.Vinay AV, Venkatesh D, Ambarish V. Impact of short-term practice of yoga on heart rate variability. Int J Yoga. 2016;9(1):62-6. doi:10.4103/0973-6131.171714.Vinay AV, Venkatesh D, Ambarish V. Impact of short-term practice of yoga on heart rate variability. Int J Yoga. 2016;9(1):62-6. doi:10.4103/0973-6131.171714.Pal A, Srivastava N, Narain VS, et al. Effect of yogic intervention on the autonomic nervous system in the patients with coronary artery disease: a randomized controlled trial. East Mediterr Health J. 2013;19(5):452-8.Pal A, Srivastava N, Narain VS, et al. Effect of yogic intervention on the autonomic nervous system in the patients with coronary artery disease: a randomized controlled trial. East Mediterr Health J. 2013;19(5):452-8.Peter R, Sood S, Ashwani Dhawan. Pectral Parameters of HRV In Yoga Practitioners, Athletes And Sedentary Males. Indian J Physiol Pharmacol. 2015;59(4):380-7.Peter R, Sood S, Ashwani Dhawan. Pectral Parameters of HRV In Yoga Practitioners, Athletes And Sedentary Males. Indian J Physiol Pharmacol. 2015;59(4):380-7.Sawane MV, Gupta SS. Resting heart rate variability after yogic training and swimming: A prospective randomized comparative trial. Int J Yoga. 2015;8(2):96-102. doi:10.4103/0973-6131.154069.Sawane MV, Gupta SS. Resting heart rate variability after yogic training and swimming: A prospective randomized comparative trial. Int J Yoga. 2015;8(2):96-102. doi:10.4103/0973-6131.154069.Saoji AA, Raghavendra BR, Manjunath NK. Effects of yogic breath regulation: A narrative review of scientific evidence. J Ayurveda Integr Med. 2019;10(1):50-58. doi:10.1016/j.jaim.2017.07.008.Saoji AA, Raghavendra BR, Manjunath NK. Effects of yogic breath regulation: A narrative review of scientific evidence. J Ayurveda Integr Med. 2019;10(1):50-58. doi:10.1016/j.jaim.2017.07.008.Posadzki P, Kuzdzal A, Soo Lee M, Ernst E. Yoga for Heart Rate Variability: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Appl Psychophysiol Biofeedback. 2015;40(3):239-49. doi:10.1007/s10484-015-9291-z.Posadzki P, Kuzdzal A, Soo Lee M, Ernst E. Yoga for Heart Rate Variability: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Appl Psychophysiol Biofeedback. 2015;40(3):239-49. doi:10.1007/s10484-015-9291-z.

The authors declare that there are no conflicts of interest present.