PHYSIOLOGICAL DETERMINANTS OF HYPERREACTIVITY TO STRESS IN BORDERLINE HYPERTENSION
PHYSIOLOGICAL DETERMINANTS OF HYPERREACTIVITY TO STRESS IN BORDERLINE HYPERTENSION
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DOI：
10.1161/01.hyp.25.3.384
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发表时间：
1995-03-01
期刊：
影响因子：
8.3
通讯作者：
LIGHT, KC
中科院分区：
文献类型：
--
作者：
SHERWOOD, A;HINDERLITER, AL;LIGHT, KC
压力时的血压高反应性是白色男性临界高血压的特征。本研究评价了这种高反应性的血流动力学基础，并评估了其交感神经系统功能的生理基础。心血管调整厌恶反应时间测试进行了比较，这些前额冷压测试，代表的压力源，引起积极的行为反应，相反，被动耐受厌恶刺激。正如预期的那样，在主动反应时间应激过程中，12名临界高血压男性的血压升高幅度大于21名年龄匹配的血压正常男性，但在被动冷压测试过程中则不然。临界性高血压患者的加压高反应性与血浆肾上腺素和去甲肾上腺素的过度升高有关，导致心输出量的更大增加，尽管有证据表明这些受试者的心脏β-肾上腺素能受体与血压正常受试者相比下调。在冷加压试验中，临界性高血压与全身血管阻力的增加有关，在压力感受器反射功能正常的情况下，全身血管阻力的增加导致心输出量的衰减，因此对血压的净影响并不比血压正常的受试者大。边缘性高血压受试者的血管肥大证据被认为是他们对冷压刺激的血管高反应性的原因。总的来说，本研究中的观察结果进一步支持了这样的观点：白色男性高血压的早期阶段以交感神经系统高反应性为特征，但仅与引起积极行为应对反应的任务相关。这些反应在何种程度上引起的典型的日常事件可能是一个重要的决定因素是否临界高血压成熟到其既定的形式，显示血流动力学特征占主导地位的血管结构变化。
Blood pressure hyperreactivity during stress is characteristic of borderline hypertension in white men. The present study evaluated the hemodynamic basis of this hyperreactivity and assessed its physiological basis in terms of sympathetic nervous system function. Cardiovascular adjustments to an aversive reaction time test were compared with these of the forehead cold presser test, representing stressors that elicit active behavioral responses in contrast to passive tolerance of aversive stimulation. As anticipated, blood pressure increases were greater in 12 borderline hypertensive men compared with 21 age-matched normotensive men during the active reaction time stressor but not during the passive cold presser test. The presser hyperreactivity in borderline hypertensives was associated with excessive rises in plasma epinephrine and norepinephrine, leading to greater increases in cardiac output, despite evidence that the cardiac beta-adrenergic receptors in these subjects were downregulated compared with those of normotensive subjects. During the cold pressor test, borderline hypertension was associated with greater increases in systemic vascular resistance, which, in the presence of normal baroreoeptor reflex function, led to an attenuation of cardiac output, thus producing no greater net effect on blood pressure than seen in normotensive subjects. Evidence of vascular hypertrophy in the borderline hypertensive subjects was considered to account for their vascular hyperreactivity to cold presser stimulation. Collectively, the observations in this study further support the view that the early stages of hypertension in white men are characterized by sympathetic nervous system hyperreactivity, but only in association with tasks that elicit active behavioral coping responses. The extent to which these responses are elicited by typical daily events may be an important determinant of whether borderline hypertension matures to its established form, which displays hemodynamic characteristics dominated by vascular structural changes.