Sympathetic nervous system, diabetes, and hypertension
Sympathetic nervous system, diabetes, and hypertension
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DOI：
10.1081/ceh-100001196
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发表时间：
2001-01-01
影响因子：
12.3
通讯作者：
Quadri, R
中科院分区：
文献类型：
--
作者：
Perin, PC;Maule, S;Quadri, R
高血压在糖尿病患者中的发生率是普通人群的两倍。它在2型糖尿病中的患病率高于1型糖尿病：在2型糖尿病中，高血压的发病通常在糖尿病诊断之前，而在后者中，高血压的出现严格地与肾病的存在有关。交感神经过度活动在糖尿病合并高血压的发病机制中起重要作用。它可能与1型糖尿病合并慢性肾功能衰竭患者肾素-血管紧张素-醛固酮(RAA)系统的激活有关，也可能与2型糖尿病合并代谢综合征患者的胰岛素抵抗/高胰岛素血症有关。在早期自主神经病变的患者中，迷走神经损伤可导致交感神经活动在交感-迷走神经平衡中相对占优势。在这些患者中，高血压发作之前通常会出现夜间血压下降的现象。交感神经过度活动刺激RAA活性，促进钠重吸收，增加心率、每搏量和外周血管阻力，从而诱发高血压和增加心血管风险。一些直接或间接作用于交感神经活动的药物可用于治疗糖尿病受试者的高血压。对于其中一些药物的代谢特征的潜在优势，人们的看法仍然相互矛盾。
Hypertension is twice as frequent in diabetic: patients than in the general population. Its prevalence is higher in Type 2 than in Type 1 diabetes: in the former, the onset of hyper-tension often precedes the diagnosis of diabetes, whereas, in the latter it is strictly related to the presence of nephropathy. Sympathetic nerve overactivity is crucial in the pathogenesis of hypertension in diabetes. It can be related to the activation of the renin-angiotensin-aldosterone (RAA) system in Type 1 diabetic patients with chronic renal failure, or to a condition of insulin resistance/hyperinsulinemia in Type 2 patients with the metabolic syndrome. In patients with early autonomic neuropathy, vagal impairment can lead to a relative predominance of sympathetic activity in the sympatho-vagal balance. In these patients, the onset of hypertension is frequently preceded by reduced nocturnal dipping. Sympathetic overactivity stimulates RAA activity, promotes sodium reabsorption, and increases heart rate, stroke volume and peripheral vascular resistance, thus inducing hypertension and increasing cardiovascular risk. A number of drugs acting either directly or indirectly on sympathetic activity an available Fur the treatment of hypertension in diabetic subjects. Opinions on the potential advantages of the metabolic profile of some of these drugs are as yet conflicting.