Morning Surge in Blood Pressure Is Associated With Reactivity of the Sympathetic Nervous System
Morning Surge in Blood Pressure Is Associated With Reactivity of the Sympathetic Nervous System
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DOI：
10.1093/ajh/hpt273
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发表时间：
2014-06-01
影响因子：
3.2
通讯作者：
Head, Geoffrey A.
中科院分区：
文献类型：
--
作者：
Lambert, Elisabeth A.;Chatzivlastou, Kanella;Head, Geoffrey A.
背景：血压（BP）的早晨激增与靶器官损伤和心血管风险密切相关，但其致病机制是否涉及交感神经系统（SNS）的更大反应性尚不清楚。我们确定SNS对冷加压试验的反应是否预测了BP晨峰。方法从14名男性和19名女性中获得了动态BP记录（年龄= 41 +/- 4岁），（昼夜差）、上升率（RoR）、振幅乘积率（BPPower）和早晨BP激增测定早晨平均动脉压（MAP）的MBPS（清醒后减去清醒前）。通过记录肌交感神经活动（MSNA）来评估SNS对CPT的反应性，CPT引起MAP和MSNA的所有参数（包括爆发振幅）显著增加。对数归一化BPPower与CPT诱导的总MSNA（r = 0.38; P = 0.04）和爆发振幅（r = 0.43; P = 0.02）的总体平均增加呈正相关，但与MSNA频率增加无关。此外，观察到CPT诱导的爆发振幅变化在BPPower和RoR的三分位数之间存在强烈的正线性趋势。BPPower和RoR与CPT引起的血流动力学变化无关。MBPS没有相关的任何CPT诱导的变化，血管或MSNA variables. CONCLUSION这些结果表明，中枢神经系统的机制，影响MSNA突发幅度的增加，在觉醒过程中也可能是根本的，在确定的速率和功率的BP上升在早晨期间。
BACKGROUNDAn exaggerated morning surge in blood pressure (BP) closely relates to target organ damage and cardiovascular risk, but whether the causative mechanism involves greater reactivity of the sympathetic nervous system (SNS) is unknown. We determined whether the response of the SNS to a cold pressor test predicted the BP morning surge.METHODSAmbulatory BP recordings were obtained from 14 men and 19 women (age = 41 +/- 4 years), and the amplitude (day-night difference), rate of rise (RoR), rate by amplitude product (BPPower), and morning BP surge (MBPS; post-awake minus pre-awake) of morning mean arterial pressure (MAP) were determined. The reactivity of the SNS to CPT was assessed by recording of muscle sympathetic nerve activity (MSNA).RESULTSCPT induced a marked increase in MAP and all parameters of MSNA, including burst amplitude. Log-normalized BPPower positively correlated with the overall average CPT-induced increases in total MSNA (r = 0.38; P = 0.04) and burst amplitude (r = 0.43; P = 0.02) but was not related to the increase in MSNA frequency. Furthermore, a strong positive linear trend in the CPT-induced changes in burst amplitude across tertiles of BPPower and RoR was observed. BPPower and RoR were not related to CPT-induced hemodynamic changes. The MBPS did not correlate with any of the CPT-induced changes in vascular or MSNA variables.CONCLUSIONSThese results suggest that the central nervous system mechanisms influencing the increase in MSNA burst amplitude during arousal may also be fundamental in determining the rate and power of BP rise during the morning period.