Marked sympathetic activation and baroreflex dysfunction in true resistant hypertension
Marked sympathetic activation and baroreflex dysfunction in true resistant hypertension
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DOI：
10.1016/j.ijcard.2014.09.138
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发表时间：
2014-12-20
影响因子：
3.5
通讯作者：
Mancia, Giuseppe
中科院分区：
文献类型：
--
作者：
Grassi, Guido;Seravalle, Gino;Mancia, Giuseppe
背景：交感神经驱动心脏和外周循环的增加是轻度和重度原发性高血压的特征。然而，在真正的顽固性高血压（RHT）中，交感神经对心血管的影响是否增强仍不确定。在接受4.6 +/- 0.3药物治疗的32例RHT患者中（平均值+/- SEM）和年龄58.6 +/- 2.1岁，35名非耐药治疗的高血压患者（HT）和19名正常血压对照（NT），所有年龄均与RHT匹配，我们测量了临床，24小时动态血压和逐搏血压（BP）、心率（HR、EKG）、肌肉交感神经交通（MSNA，显微神经造影）和自发性压力反射MSNA敏感性。RHT患者的血压值明显高于NT和HT（172.2 +/- 1.7/100.7 +/- 1.2 vs 132.1 +/- 1.3/82.1 +/- 0.9和135.5 +/- 1.2/83.6 +/- 0.9 mm Hg，P < 0.01）。这被MSNA的显著和显著增加所证实（87.8 +/- 2.0 vs 46.8 +/- 2.6和59.3 +/- 1.7和爆发/100次心跳，P < 0.01）。在多元回归分析中，在RHT中观察到的MSNA增加与血流动力学、激素和代谢变量显著相关。它还与血浆醛固酮值以及自发性压力反射MSNA敏感性显著相关，在校正混杂因素（包括抗高血压治疗）后，这些变量在多变量分析中与RHT的肾上腺素能激活更密切相关（r（partial）（2）= 0.04405和r（partial）（2）= 0.00878，P均< 0.05）。结论：这些数据首次证明RHT是一种明显的肾上腺素能受体激动状态，其强度大于HT。他们还认为，受损的压力反射机制，沿着血流动力学和神经体液因素，可能是造成这种现象的原因。(C)2014爱思唯尔爱尔兰有限公司版权所有。
Background: An increase in sympathetic drive to the heart and the peripheral circulation characterizes mild and severe essential hypertension. However, it remains unsettled whether sympathetic cardiovascular influences are potentiated in true resistant hypertension (RHT).Methods: In 32 RHT patients treated with 4.6 +/- 0.3 drugs (mean +/- SEM) and aged 58.6 +/- 2.1 years, 35 nonresistant treated hypertensives (HT) and 19 normotensive controls (NT), all age-matched with RHT, we measured clinic, 24-hour ambulatory and beat-to-beat blood pressures (BP), heart rate (HR, EKG), muscle sympathetic nerve traffic (MSNA, microneurography) and spontaneous baroreflex MSNA-sensitivity.Results: BP values were markedly greater in RHT patients than in NT and HT (172.2 +/- 1.7/100.7 +/- 1.2 vs 132.1 +/- 1.3/82.1 +/- 0.9 and 135.5 +/- 1.2/83.6 +/- 0.9 mm Hg, P < 0.01). This was paralleled by a significant and marked increase in MSNA (87.8 +/- 2.0 vs 46.8 +/- 2.6 and 59.3 +/- 1.7 and bursts/100 heartbeats, P < 0.01). In multiple regression analysis the MSNA increase observed in RHT was significantly related to hemodynamic, hormonal and metabolic variables. It was also significantly related to plasma aldosterone values as well as spontaneous baroreflex MSNA-sensitivity, which were the variables that at the multivariate analysis were more closely related to the adrenergic activation of RHT after adjustment for confounders, including antihypertensive treatment (r(partial)(2) = 0.04405 and r(partial)(2) = 0.00878, P < 0.05 for both).Conclusions: These data represent the first evidence that RHT is a state of marked adrenergic overdrive, greater for magnitude than that detectable in HT. They also suggest that impaired baroreflex mechanisms, along with hemodynamic and neurohumoral factors, may be responsible for the phenomenon. (C) 2014 Elsevier Ireland Ltd. All rights reserved.