Whole‐Body Circulatory Autoregulation and Hypertension
Whole‐Body Circulatory Autoregulation and Hypertension
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全身循环自动调节和高血压
DOI：
10.1161/01.res.28.5.ii-76
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发表时间：
1971
影响因子：
20.1
通讯作者：
A. C. Guyton
中科院分区：
文献类型：
--
作者：
T. Coleman;H. Granger;A. C. Guyton
动脉压升高的一个可能原因涉及血流自动调节和动脉血压控制之间的相互关系。理论上，自动调节反应可导致动脉压升高和外周阻力升高，心输出量正常或接近正常。一些实验研究支持这一理论。血流的自动调节已经在身体的许多组织中观察到，并且在反射犬中已经证明了全身自动调节的总和效应。心输出量增加先于总外周阻力增加，心输出量减少先于总外周阻力减少。系统的增益经计算略大于3。在高血压发病时也观察到了同样的血流动力学模式，即心输出量增加先于阻力增加。我们已经观察到在犬中盐诱导的高血压开始时和在无肾患者中继发于液体体积扩张的高血压开始时心输出量增加，而其他研究者已经在许多情况下观察到这种血流动力学模式，包括不稳定性高血压、肾周高血压和Goldblatt高血压。心输出量增加可能由几个因素引起，尽管在许多情况下，原因似乎是液体潴留。在高血压逆转过程中观察到的血流动力学反应表明涉及全身自动调节，即心输出量减少先于外周阻力减少。脱水过度（和高血压）无肾患者和Goldblatt高血压患者的肾动脉开放，以及对高血压患者给予利尿剂或其他几种降压药物，都是这种模式的例证。从理论上讲，肾脏在高血压中的作用是通过引起液体潴留来启动自动调节反应，或者通过防止动脉压升高时液体流失来允许自动调节反应发生。
A possible cause of elevated arterial pressure involves the interrelationship between autoregulation of blood flow and control of arterial blood pressure. An autoregulatory response could theoretically result in an elevated arterial pressure and an elevated peripheral resistance with normal or nearly normal cardiac output. Several experimental studies support this theory. Autoregulation of blood flow has been observed in a number of the body's tissues, and the summated effect, whole-body autoregulation, has been demonstrated in areflex dogs. An increase in cardiac output precedes an increase in total peripheral resistance, and a decrease in cardiac output precedes a decrease in total peripheral resistance. The gain of the system was calculated to be slightly greater than three. This same hemodynamic pattern, that is, an increase in cardiac output preceding an increase in resistance, has been observed at the onset of hypertension. We have observed increases in cardiac output at the beginning of salt-induced hypertension in dogs and at the beginning of hypertension secondary to fluid volume expansion in anephric patients, while other investigators have observed this hemodynamic pattern in a number of instances, including labile hypertension, perinephritis hypertension, and Goldblatt hypertension. The increased cardiac output can be caused by several factors, although in many instances the cause appears to be fluid retention. A hemodynamic response suggesting the involvement of whole-body autoregulation, that is, a decrease in cardiac output precedes a decrease in peripheral resistance, has been observed in the reversal of hypertension. Dehydrating overhydrated (and hypertensive) anephric patients and unclipping the renal artery in Goldblatt hypertension elicits this pattern, as well as administration of diuretics or several other antihypertensive drugs to hypertensives. Theoretically, the role of the kidney in hypertension is either to initiate the autoregulatory response by causing fluid retention or to allow the autoregulatory response to occur by preventing the loss of fluid in the face of an elevated arterial pressure.