Sympathetic nervous system activation in essential hypertension, cardiac failure and psychosomatic heart disease
Sympathetic nervous system activation in essential hypertension, cardiac failure and psychosomatic heart disease
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DOI：
10.1097/00005344-200000004-00001
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发表时间：
2000-01-01
影响因子：
3
通讯作者：
Kaye, D
中科院分区：
文献类型：
--
作者：
Esler, M;Kaye, D
可以使用测量交感神经放电速率的电生理学方法和提供从个体器官中的交感神经向血浆的去甲肾上腺素溢出的定量的神经化学技术来研究人类的区域交感神经活动。原发性高血压：在患有原发性高血压的患者中的这种测量揭示了交感神经流出到骨骼肌血管、心脏和肾脏的激活，特别是在年轻患者中。这种交感神经激活除了支持血压升高之外，还很可能导致左心室肥大，以及通常相关的胰岛素抵抗和胰岛素血症的代谢异常。抗高血压药物，如莫索尼定，主要通过抑制交感神经系统发挥作用，在预防高血压并发症方面，除了降低血压外，还应具有其他临床获益。肥胖相关的高血压：了解肥胖者高血压的神经病理生理学一直很困难。在血压正常的肥胖症患者中，肾脏交感神经张力增加一倍，但心脏去甲肾上腺素溢出（心脏交感神经活动的衡量标准）仅为正常值的50%。在肥胖相关的高血压中，肾脏去甲肾上腺素溢出有相当的升高，但没有抑制心脏交感神经（心脏交感神经活性是血压正常的肥胖者的两倍多，比健康志愿者高25%）。肥胖患者肾交感神经活动增加可能是高血压发展的“必要”原因（并易导致高血压发展），但显然不是“充分”原因。肥胖者发生高血压的区别特征是缺乏血压正常的肥胖者心脏交感神经张力的适应性抑制。心力衰竭：在心力衰竭中，心脏的交感神经优先受到刺激。在未治疗的患者中，静息时衰竭心脏释放的去甲肾上腺素增加多达50倍，类似于在接近最大运动期间在健康心脏中观察到的水平。心脏交感神经流出的激活为衰竭心肌提供肾上腺素能支持，但以心律失常发展和进行性心肌恶化为代价。心身性心脏病：不超过50%的临床冠心病可以用经典的心脏危险因素来解释。有越来越多的证据表明，心理异常，特别是抑郁症，焦虑状态，包括恐慌症和精神压力，参与了“触发”临床心血管事件，也可能有助于动脉粥样硬化的发展。精神压力和精神疾病导致心脏病风险增加的机制尚不完全清楚，但交感神经系统的激活似乎是最重要的。
Regional sympathetic activity can be studied in humans using electrophysiological methods measuring sympathetic nerve firing rates and neurochemical techniques providing quantification of noradrenaline spillover to plasma from sympathetic nerves in individual organs. Essential hypertension: Such measurements in patients with essential hypertension disclose activation of the sympathetic outflows to skeletal muscle blood vessels, the heart and kidneys, particularly in younger patients. This sympathetic activation, in addition to underpinning the blood pressure elevation, most likely also contributes to left ventricular hypertrophy, and to the commonly associated metabolic abnormalities of insulin resistance and hyperlipidaemia. Antihypertensive drugs, such as moxonidine, which act primarily by inhibiting the sympathetic nervous system, should have additional clinical benefits beyond those attributable to blood pressure reduction, in protecting against hypertensive complications. Obesity-related hypertension: Understanding the neural pathophysiology of hypertension in the obese has been difficult. In normotensive obesity, renal sympathetic tone is doubled, but cardiac noradrenaline spillover (a measure of sympathetic activity in the heart) is only 50% of normal. In obesity-related hypertension, there is a comparable elevation of renal noradrenaline spillover, but without suppression of cardiac sympathetics (cardiac sympathetic activity bring more than double that of normotensive obese and 25% higher than in healthy volunteers). Increased renal sympathetic activity in obesity may be a 'necessary' cause for the development of hypertension (and predisposes to hypertension development), but apparently is not a 'sufficient' cause. The discriminating feature of the obese who develop hypertension is the absence of the adaptive suppression of cardiac sympathetic tone seen in the normotensive obese. Heart failure: In cardiac failure, the sympathetic nerves of the heart are preferentially stimulated. Noradrenaline release from the failing heart at rest in untreated patients is increased as much as 50-fold, similar to the level seen in the healthy heart during near-maximal exercise, Activation of the cardiac sympathetic outflow provides adrenergic support to the failing myocardium, but at a cost of arrhythmia development and progressive myocardial deterioration. Psychosomatic heart disease: No more than 50% of clinical coronary heart disease is explicable in terms of classical cardiac risk factors. There is gathering evidence that psychological abnormalities, particularly depressive illness, anxiety states, including panic disorder and mental stress, are involved hen,'triggering' clinical cardiovascular events, and possibly also contributing to atherosclerosis development. The mechanisms of increased cardiac risk attributable to mental stress and psychiatric illness are not entirely clear, but activation of the sympathetic nervous system seems to be of prime importance.