Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.A.G., T.J., D.L.).
Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany (F.M.).
Hypertension. 2024 Oct;81(10):2027-2037. doi: 10.1161/HYPERTENSIONAHA.123.19460. Epub 2024 Aug 13.
More than 1.5 billion people worldwide have arterial hypertension. Hypertension increases the risks of death and cardiovascular disease, such as atrial fibrillation and heart failure. The autonomic nervous system plays an essential role in hypertension development and disease progression. While lifestyle factors, such as obesity and obstructive sleep apnea, predispose to hypertension by increasing sympathetic activity, hypertension itself maintains the autonomic nervous imbalance, providing the substrate for atrial fibrillation and heart failure. Therefore, autonomic nervous system modulation either by direct targeting or indirect treatment of comorbidities has the potential to treat both hypertension and related atrial and ventricular end-organ damage. We discuss interventions for the modulation of the autonomic nervous system for hypertension and related cardiac end-organ damage, including pharmacological adrenergic beta-receptor blockade, renal denervation, carotid baroreceptor stimulation, low-level vagal stimulation, and ablation of ganglionated plexuses. In summary, the literature suggests that targeting the autonomic nervous system potentially represents a therapeutic approach to prevent atrial and ventricular end-organ damage in patients with hypertension. However, clinical trials specifically designed to test the effect of autonomic modulation on hypertension-mediated cardiac end-organ damage are scarce.
全球有超过 15 亿人患有动脉高血压。高血压会增加死亡和心血管疾病（如心房颤动和心力衰竭）的风险。自主神经系统在高血压的发展和疾病进展中起着至关重要的作用。虽然生活方式因素，如肥胖和阻塞性睡眠呼吸暂停，通过增加交感神经活动使高血压更容易发生，但高血压本身会维持自主神经失衡，为心房颤动和心力衰竭提供基础。因此，自主神经系统的调节，无论是通过直接针对还是间接治疗合并症，都有可能治疗高血压和相关的心房和心室终末器官损伤。我们讨论了用于调节自主神经系统的干预措施，以治疗高血压和相关的心脏终末器官损伤，包括药理学肾上腺素能β受体阻滞剂、肾去神经支配、颈动脉压力感受器刺激、低水平迷走神经刺激和神经节丛消融。总之，文献表明，靶向自主神经系统可能是预防高血压患者心房和心室终末器官损伤的一种治疗方法。然而，专门设计用于测试自主调节对高血压介导的心脏终末器官损伤影响的临床试验却很少。
