Weidmann P
Medizinische Poliklinik, University of Berne, Switzerland.
Clin Exp Hypertens A. 1989;11 Suppl 1:257-73. doi: 10.3109/10641968909045430.
In normotensive humans with a positive family history of essential hypertension, blood pressure (BP) is often dysregulated. Body sodium, blood volume, plasma angiotensin II (AngII), epinephrine and norepinephrine (NE), their responses to changes in sodium intake or posture, as well as baroreflex function, beta-receptor-mediated cardiac responsiveness, and the responsiveness of BP to AngII appear to be largely unaltered. However, the responsiveness of BP to NE is commonly exaggerated. An increase in potassium intake may improve the NE hyperreactivity and concomitantly lower BP within the "normotensive" range. Therefore, a selective vascular NE hyperreactivity relative to existing sympathetic activity seems to be a common familial abnormality predisposing for the development of essential hypertension. In borderline or established essential hypertension, an inappropriate vascular reactivity relative to sympathetic activity probably complements other mechanisms contributing to the maintenance of hypertension. Various antihypertensive treatments may lower BP at least in part by improving cardiovascular NE (hyper)reactivity without provoking an equivalent rise in sympathetic activity. These include dietary potassium supplementation, thiazide-type agents, indapamide, calcium channel blockers, postsynaptic alpha 1-blockers, and AngII converting enzyme inhibitors.
在有原发性高血压家族史的血压正常人群中，血压（BP）常常调节异常。机体钠、血容量、血浆血管紧张素II（AngII）、肾上腺素和去甲肾上腺素（NE）、它们对钠摄入或体位变化的反应，以及压力反射功能、β受体介导的心脏反应性和血压对AngII的反应性似乎基本未改变。然而，血压对NE的反应性通常会增强。增加钾摄入量可能会改善NE的高反应性，并在“血压正常”范围内使血压随之降低。因此，相对于现有的交感神经活动，选择性血管NE高反应性似乎是原发性高血压发生的一种常见家族性异常。在临界或确诊的原发性高血压中，相对于交感神经活动而言不适当的血管反应性可能补充了导致高血压维持的其他机制。各种抗高血压治疗至少部分可通过改善心血管NE（高）反应性而降低血压，同时不会引发交感神经活动等量增加。这些治疗包括补充膳食钾、噻嗪类药物、吲达帕胺、钙通道阻滞剂、突触后α1阻滞剂和AngII转换酶抑制剂。
