Lohmeier Thomas E, Iliescu Radu
Department of Physiology, University of Mississippi Medical Center, Jackson, MS, USA.
Handb Clin Neurol. 2013;117:395-406. doi: 10.1016/B978-0-444-53491-0.00032-8.
Recent technical advances have renewed interest in device-based therapy for the treatment of drug-resistant hypertension. Findings from recent clinical trials regarding the efficacy of electrical stimulation of the carotid sinus for the treatment of resistant hypertension are reviewed here. However, a major goal of this article is to summarize experimental studies that have provided a conceptual understanding of the mechanisms that account for the long-term blood pressure lowering of arterial pressure with baroreflex activation. In so doing, the mechanistic insight from these studies may help to identify subsets of this heterogeneous population that stand to benefit the most. In this regard, because clinical, experimental, and theoretical evidence indicates that the kidneys play a dominant role in long-term control of arterial pressure, this article focuses on the mechanisms that link baroreflex-induced reductions in central sympathetic outflow with increases in renal excretory function that lead to sustained reductions in arterial pressure. Despite the encouraging findings from recent clinical trials, more basic research and additional clinical trials are needed to better define the benefit of baroreflex activation therapy in resistant hypertension and in other states of sympathetic activation such as heart failure and advanced renal disease.
最近的技术进步重新激发了人们对基于器械的疗法治疗顽固性高血压的兴趣。本文回顾了近期关于颈动脉窦电刺激治疗顽固性高血压疗效的临床试验结果。然而，本文的一个主要目标是总结实验研究，这些研究使人们对压力反射激活导致动脉压长期降低的机制有了概念性的理解。这样做的话，这些研究的机制性见解可能有助于识别这一异质性人群中最受益的亚组。在这方面，由于临床、实验和理论证据表明肾脏在动脉压的长期控制中起主导作用，本文重点关注将压力反射引起的中枢交感神经输出减少与肾排泄功能增加联系起来的机制，而肾排泄功能增加会导致动脉压持续降低。尽管近期临床试验有令人鼓舞的结果，但仍需要更多的基础研究和额外的临床试验，以更好地确定压力反射激活疗法在顽固性高血压以及其他交感神经激活状态（如心力衰竭和晚期肾病）中的益处。
