Portaluppi F, Montanari L, Ferlini M, Vergnani L, Bagni B, Degli Uberti E C
Endocrinology Section, University of Ferrara, Italy.
Eur Heart J. 1992 Jul;13(7):990-6. doi: 10.1093/oxfordjournals.eurheartj.a060305.
The mechanisms underlying altered BP regulation in congestive heart failure are unknown. This study examines the possibility that differences in circadian blood pressure (BP) regulation between the normal and the failing heart correlate with changes in the circulating pattern of atrial natriuretic peptide (ANP). Twelve normotensive patients with coronary artery disease were studied over two separate 24-h periods, the first during acute exacerbation of congestive heart failure (radionuclide-determined ejection fraction at rest was less than 30%) and the second after therapy-induced functional recovery (ejection fraction was more than 40%). BP monitoring at 10-min intervals and intra-atrial blood samples for ANP assays at hourly intervals were obtained. Significant correlation between ejection fraction and the indexes of circadian BP variability (standard deviation of the 24-h pressure mean and day-night pressure difference) were found both before and after treatment. Ejection fraction was independent of the BP means (24-h, daytime and night-time). BP variability, 24-h mean and daytime mean were higher after treatment. ANP means were lower after treatment, whereas ANP variability was higher. The indexes of BP and ANP variability correlated both before and after treatment, whereas the BP and the ANP means were independent. These findings demonstrate that differences in BP regulation of CHF before and after effective treatment correlate with changes in the circulating pattern of ANP. We speculate that by modulating ANP release, the heart could be actively involved in BP regulation as part of the compensatory mechanisms aimed at protecting against circulatory overload.
充血性心力衰竭中血压调节改变的潜在机制尚不清楚。本研究探讨了正常心脏与衰竭心脏之间昼夜血压调节差异与心房利钠肽（ANP）循环模式变化相关的可能性。对12名患有冠状动脉疾病的血压正常患者进行了两个独立的24小时观察期研究，第一个观察期为充血性心力衰竭急性加重期（静息时放射性核素测定的射血分数小于30%），第二个观察期为治疗诱导功能恢复后（射血分数大于40%）。每隔10分钟监测一次血压，并每隔一小时采集一次心房内血样用于ANP检测。治疗前后均发现射血分数与昼夜血压变异性指标（24小时平均血压标准差和昼夜血压差值）之间存在显著相关性。射血分数与血压均值（24小时、白天和夜间）无关。治疗后血压变异性、24小时均值和白天均值均升高。治疗后ANP均值降低，而ANP变异性升高。治疗前后血压和ANP变异性指标均相关，而血压和ANP均值相互独立。这些发现表明，有效治疗前后充血性心力衰竭血压调节的差异与ANP循环模式的变化相关。我们推测，通过调节ANP释放，心脏可能作为旨在防止循环超负荷的代偿机制的一部分，积极参与血压调节。
