Johnson Randall S, Titze Jens, Weller Richard
aDepartment of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK bDivision of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA cInterdisciplinary Center for Clinical Research, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany dUniversity Department of Dermatology, University of Edinburgh, Lauriston Building, Lauriston Place, Edinburgh, UK.
Curr Opin Nephrol Hypertens. 2016 Jan;25(1):11-5. doi: 10.1097/MNH.0000000000000188.
Textbook theory holds that blood pressure (BP) is regulated by the brain, by blood vessels, or by the kidney. Recent evidence suggests that BP could be regulated in the skin.
The skin holds a complex capillary counter current system, which controls body temperature, skin perfusion, and apparently systemic BP. Epidemiological data suggest that sunlight exposure plays a role in controlling BP. Ultraviolet A radiation produces vasodilation and a fall in BP. Keratinocytes and immune cells control blood flow in the extensive countercurrent loop system of the skin by producing nitric oxide, a key regulator of vascular tone. The balance between hypoxia-inducible factor-1α and hypoxia-inducible factor-2α activity in keratinocytes controls skin perfusion, systemic thermoregulation, and systemic BP by nitric oxide-dependent mechanisms. Furthermore, the skin accumulates Na which generates a barrier to promote immunological host defense. Immune cells control skin Na metabolism and the clearance of Na via the lymphatic system. Reduced lymphatic clearance increases BP.
Apart from the well-known role of the brain, blood vessels, and the kidney, the skin is important for systemic BP control in humans and in experimental animals.
教科书理论认为血压（BP）由大脑、血管或肾脏调节。近期证据表明皮肤也可能参与血压调节。
皮肤拥有复杂的毛细血管逆流系统，该系统控制体温、皮肤灌注，显然也控制全身血压。流行病学数据表明阳光照射在控制血压方面发挥作用。紫外线A辐射可引起血管舒张和血压下降。角质形成细胞和免疫细胞通过产生一氧化氮（血管张力的关键调节因子）来控制皮肤广泛逆流环系统中的血流。角质形成细胞中缺氧诱导因子-1α和缺氧诱导因子-2α活性之间的平衡通过一氧化氮依赖性机制控制皮肤灌注、全身体温调节和全身血压。此外，皮肤会积累钠，形成一道屏障以促进免疫宿主防御。免疫细胞控制皮肤钠代谢以及通过淋巴系统清除钠。淋巴清除减少会导致血压升高。
除了大脑、血管和肾脏的众所周知的作用外，皮肤对人类和实验动物的全身血压控制也很重要。
