Human sympathetic nerve biology: Parallel influences of stress and epigenetics in essential hypertension and panic disorder

Abstract

Patients with panic disorder provide a clinical model of stress. On a "good day," free from a panic attack, they show persistent stress-related changes in sympathetic nerve biology, including abnormal sympathetic nerve single-fiber firing ("salvos" of multiple firing within a cardiac cycle) and release of epinephrine as a cotransmitter. The coreleased epinephrine perhaps originates from in situ synthesis by phenylethanolamine N-methyltransferase (PNMT). In searching for biological evidence that essential hypertension is caused by mental stress - a disputed proposition - we note parallels with panic disorder, which provides an explicit clinical model of stress: (1) There is clinical comorbidi..