Comeau Kevin D, Shokoples Brandon G, Schiffrin Ernesto L
Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, McGill University, Montréal, Québec, Canada.
Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, McGill University, Montréal, Québec, Canada; Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Québec, Canada.
Can J Cardiol. 2022 Dec;38(12):1828-1843. doi: 10.1016/j.cjca.2022.05.010. Epub 2022 May 18.
Hypertension is the leading risk factor for cardiovascular disease and mortality worldwide. Despite intensive research into the mechanisms underlying the development of hypertension, it remains difficult to control blood pressure in a large proportion of patients. Young men have a higher prevalence of hypertension compared with age-matched women, and this holds true until approximately the fifth decade of life. Following the onset of menopause, the incidence of hypertension among women begins to surpass that of men. The immune system has been demonstrated to play a role in the pathophysiology of hypertension, and biological sex and sex hormones can affect the function of innate and adaptive immune cell populations. Recent studies in male and female animal models of hypertension have begun to unravel the relationship among sex, immunity, and hypertension. Hypertensive male animals show a bias toward proinflammatory T-cell subsets, including interleukin (IL) 17-producing T17 cells, and increased renal infiltration of T cells and inflammatory macrophages. Conversely, premenopausal female animals are largely protected from hypertension, and have a predilection for anti-inflammatory T regulatory cells and production of anti-inflammatory cytokines, such as IL-10. Menopause abrogates female protection from hypertension, which may be due to changes among anti-inflammatory T regulatory cell populations. Since development of novel treatments for hypertension has plateaued, determining the role of sex in the pathophysiology of hypertension may open new therapeutic avenues for both men and women.
高血压是全球心血管疾病和死亡的主要危险因素。尽管对高血压发病机制进行了深入研究，但在很大一部分患者中，控制血压仍然困难。与年龄匹配的女性相比，年轻男性高血压患病率更高，这种情况一直持续到大约五十岁左右。绝经后，女性高血压发病率开始超过男性。免疫系统已被证明在高血压病理生理学中起作用，生物性别和性激素可影响先天和适应性免疫细胞群的功能。最近在高血压雄性和雌性动物模型中的研究开始揭示性别、免疫和高血压之间的关系。高血压雄性动物倾向于促炎T细胞亚群，包括产生白细胞介素（IL）-17的T17细胞，并且T细胞和炎性巨噬细胞在肾脏的浸润增加。相反，绝经前雌性动物在很大程度上免受高血压影响，并且倾向于产生抗炎性调节性T细胞和抗炎细胞因子，如IL-10。绝经消除了女性对高血压的保护作用，这可能是由于抗炎性调节性T细胞群的变化所致。由于高血压新疗法的开发已趋于平稳，确定性别在高血压病理生理学中的作用可能为男性和女性开辟新的治疗途径。
