The changing face of sympathetic overactivity in hypertension

被引:80
作者
Julius, S [1 ]
Majahalme, S
机构
[1] Univ Michigan Hlth Syst, Dept Internal Med, Div Hypertens, Taubman Ctr 3918, Ann Arbor, MI 48109 USA
[2] Tampere Univ Hosp, Tampere, Finland
[3] Univ Tampere, Dept Internal Med, Div Cardiol, FIN-33101 Tampere, Finland
关键词
blood pressure; hypertension; insulin resistance; overweight; sympathetic tone;
D O I
10.3109/07853890008995939
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
There is a lot of evidence showing that sympathetic activity is increased in a large proportion of patients with hypertension. However, the clinical impact of this state is frequently underestimated. Several factors seem to be misunderstood, such as whether sympathetic overactivity is reproducibly present, whether it lasts throughout 24 h, and what is the significance of its association with tachycardia. In this review, we present data to indicate that several haemodynamic changes in hypertension such as elevated cardiac output. and heart rate and alteration in vascular resistance are neurogenic. The relationship between the increased sympathetic tone and decreased parasympathetic tone in hypertension is reciprocal, which strongly suggests that the abnormality emanates from the brain. The increase in sympathetic drive in hypertension is widespread across many organs. Beside the heart it is seen in the kidney and skeletal muscle, and even in platelets. We also discuss the possible mechanisms of the haemodynamic transition from this hyperkinetic state to established hypertension. We propose a hypothesis where down-regulation of beta-adrenergic responsiveness plays a major role in explaining the haemodynamic changes as well as metabolic alterations, such as hyperinsulinaemia and even the gain of weight in hypertension. Thus, the increased sympathetic tone may be involved in the genesis of multiple, pressure-independent coronary risk factors in hypertension.
引用
收藏
页码:365 / 370
页数:6
相关论文
共 55 条
[41]  
Lund-Johansen P., 1983, MILD HYPERTENSION RE, P237
[42]   BLOOD-PRESSURE, STROKE, AND CORONARY HEART-DISEASE .1. PROLONGED DIFFERENCES IN BLOOD-PRESSURE - PROSPECTIVE OBSERVATIONAL STUDIES CORRECTED FOR THE REGRESSION DILUTION BIAS [J].
MACMAHON, S ;
PETO, R ;
CUTLER, J ;
COLLINS, R ;
SORLIE, P ;
NEATON, J ;
ABBOTT, R ;
GODWIN, J ;
DYER, A ;
STAMLER, J .
LANCET, 1990, 335 (8692) :765-774
[43]   BORDERLINE HYPERTENSION - RELATIONSHIP BETWEEN AGE, HEMODYNAMICS AND CIRCULATING CATECHOLAMINES [J].
MESSERLI, FH ;
FROHLICH, ED ;
SUAREZ, DH ;
REISIN, E ;
DRESLINSKI, GR ;
DUNN, FG ;
COLE, FE .
CIRCULATION, 1981, 64 (04) :760-764
[44]   Heart rate and the cardiovascular risk [J].
Palatini, P ;
Julius, S .
JOURNAL OF HYPERTENSION, 1997, 15 (01) :3-17
[45]   METABOLIC EFFECTS OF DILTIAZEM AND ATENOLOL - RESULTS FROM A RANDOMIZED, DOUBLE-BLIND-STUDY WITH PARALLEL GROUPS [J].
POLLARE, T ;
LITHELL, H ;
MORLIN, C ;
PRANTARE, H ;
HVARFNER, A ;
LJUNGHALL, S .
JOURNAL OF HYPERTENSION, 1989, 7 (07) :551-559
[46]   APPLICATION OF PRAZOSIN IS ASSOCIATED WITH AN INCREASE OF INSULIN SENSITIVITY IN OBESE PATIENTS WITH HYPERTENSION [J].
POLLARE, T ;
LITHELL, H ;
SELINUS, I ;
BERNE, C .
DIABETOLOGIA, 1988, 31 (07) :415-420
[47]  
PYORALA K, 1985, ACTA MED SCAND, P38
[48]   Hyperinsulinemia predicts coronary heart disease risk in healthy middle-aged men -: The 22-year follow-up results of the Helsinki Policemen Study [J].
Pyörälä, M ;
Miettinen, H ;
Laakso, M ;
Pyörälä, K .
CIRCULATION, 1998, 98 (05) :398-404
[49]   HEMODYNAMIC STUDY OF 85 PATIENTS WITH BORDERLINE HYPERTENSION [J].
SAFAR, ME ;
WEISS, YA ;
LEVENSON, JA ;
LONDON, GM ;
MILLIEZ, PL .
AMERICAN JOURNAL OF CARDIOLOGY, 1973, 31 (03) :315-319
[50]   Hyperinsulinemia is associated with the incidence of hypertension and dyslipidemia in middle-aged men [J].
Salonen, JT ;
Lakka, TA ;
Lakka, HM ;
Valkonen, VP ;
Everson, SA ;
Kaplan, GA .
DIABETES, 1998, 47 (02) :270-275