Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA.
Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
FASEB J. 2020 Sep;34(9):11337-11346. doi: 10.1096/fj.202001006RR. Epub 2020 Aug 10.
In this brief review, we summarize the current knowledge on the complex interplay between metabolism, sympathetic activity and hypertension with a focus on sex differences and changes with age in humans. Evidence suggests that in premenopausal women, sex hormones, particularly estrogen exerts a profound cardioprotective effect which may be associated with favorable metabolic profiles, as well as lower sympathetic activity and blood pressure at rest and any given physiological and environmental stimuli compared with men of a similar age. Along this line, premenopausal women seem to be generally protected from obesity-induced metabolic and cardiovascular complications. However, postmenopausal estrogen deprivation during midlife and older age has a detrimental impact on metabolism, may lead to adipose tissue redistribution from the subcutaneous to abdominal area, and augments sympathetic activity. All these changes could contribute significantly to the higher prevalence of hypertension and greater cardiometabolic risk in older women than older men. It is proposed that obesity-related hypertension has a neurogenic component which is characterized by sympathetic overactivity, but the impact of sex and age remains largely unknown. Understanding sex and age-specific differences in obesity and sympathetic neural control of blood pressure is important in the prevention and/or risk reduction of cardiometabolic disorders for both men and women.
在这篇简要的综述中，我们总结了目前关于代谢、交感活动与高血压之间复杂相互作用的知识，重点关注了性别差异和人类随年龄变化的相关情况。有证据表明，在绝经前女性中，性激素，特别是雌激素，发挥了深远的心脏保护作用，这可能与良好的代谢特征、较低的静息时及任何特定生理和环境刺激时的交感活性和血压有关，而同龄男性则没有这些特征。基于这一点，绝经前女性似乎通常能够免受肥胖引起的代谢和心血管并发症的影响。然而，中年和老年绝经后雌激素缺乏对代谢有不利影响，可能导致脂肪组织从皮下向腹部重新分布，并增加交感神经活性。所有这些变化可能会显著增加老年女性高血压和更高的心血管代谢风险，超过老年男性。有人提出，肥胖相关高血压具有神经源性成分，其特征是交感神经活性过度，但是性别和年龄的影响在很大程度上仍不清楚。了解肥胖和血压的交感神经控制方面的性别和年龄特异性差异，对于预防和/或降低男性和女性的心血管代谢疾病风险非常重要。
