Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.
Hypertens Res. 2023 Jul;46(7):1727-1737. doi: 10.1038/s41440-023-01272-4. Epub 2023 Apr 12.
Heart failure (HF) in the elderly is an increasingly large and complex problem in modern society. Notably, the cause of HF with preserved ejection fraction (HFpEF) is multifactorial and its pathophysiology is not fully understood. Among these, hypertension has emerged as a pivotal factor in the pathophysiology and therapeutic targets of HFpEF. Neuronal elements distributed throughout the cardiac autonomic nervous system, from the level of the central autonomic network including the insular cortex to the intrinsic cardiac nervous system, regulate the human cardiovascular system. Specifically, increased sympathetic nervous system activity due to sympatho-vagal imbalance is suggested to be associated the relationship between hypertension and HFpEF. While several new pharmacological therapies, such as sodium-glucose cotransporter 2 inhibitors, have been shown to be effective in HFpEF, neuromodulatory therapies of renal denervation and vagus nerve stimulation (VNS) have received recent attention. The current review explores the pathophysiology of the brain-heart axis that underlies the relationship between hypertension and HFpEF and the rationale for therapeutic neuromodulation of HFpEF by non-invasive transcutaneous VNS.
老年人心力衰竭（HF）是现代社会中一个日益严重且复杂的问题。值得注意的是，射血分数保留的心力衰竭（HFpEF）的病因是多因素的，其病理生理学尚未完全阐明。在这些因素中，高血压已成为 HFpEF 病理生理学和治疗靶点的关键因素。分布在心脏自主神经系统各个部位的神经元，从包括脑岛皮层在内的中枢自主神经网络到内在心脏神经系统，调节着人体的心血管系统。具体而言，由于交感-迷走神经失衡导致的交感神经系统活性增加被认为与高血压和 HFpEF 之间存在关联。虽然几种新的药理学治疗方法，如钠-葡萄糖共转运蛋白 2 抑制剂，已被证明对 HFpEF 有效，但肾去神经和迷走神经刺激（VNS）的神经调节治疗最近受到了关注。本综述探讨了高血压和 HFpEF 之间关系的脑-心轴的病理生理学，并探讨了通过非侵入性经皮 VNS 对 HFpEF 进行治疗性神经调节的基本原理。
