Messerli F H, Ventura H O, Reisin E, Dreslinski G R, Dunn F G, MacPhee A A, Frohlich E D
Circulation. 1982 Jul;66(1):55-60. doi: 10.1161/01.cir.66.1.55.
Systemic, renal and splanchnic hemodynamics, intravascular volume, circulating catecholamine levels and plasma renin activity were compared in 39 patients with borderline hypertension and 28 normotensive subjects, who were less than 5% (n = 42, lean patients) or more than 40% overweight (n = 25, obese patients). Lean borderline hypertensive patients had greater cardiac output (p less than 0.05), heart rate (p less than 0.01) and renal blood flow (p less than 0.05); cardiopulmonary redistribution of intravascular volume (p less than 0.05); and higher circulating norepinephrine levels (p less than 0.05). Obese normotensive subjects also showed an increased cardiac output (p less than 0.005), stroke volume (p less than 0.01), left ventricular stroke work (p less than 0.05), and renal blood flow (p less than 0.05) (but not respective indexes), but intravascular volume was expanded (p less than 0.05) without redistribution and circulating catecholamine levels were normal. Obese borderline hypertensive patients had hemodynamic characteristics similar to those of obese normotensive subjects except for an increased peripheral resistance (p less than 0.05). The data indicate that although both populations have an increased cardiac output, the lean borderline hypertensive patients have signs of enhanced adrenergic activity as evidenced by higher circulating catecholamine levels and heart rate with blood volume translocation to the cardiopulmonary circulation. In contrast, the obese subjects (whether normotensive or borderline hypertensive), who also have increased cardiac output, seem to have normal adrenergic activity and an expanded intravascular volume without cardiopulmonary redistribution.
对39例临界高血压患者和28例血压正常者的全身、肾脏和内脏血流动力学、血管内容量、循环儿茶酚胺水平及血浆肾素活性进行了比较，这些患者体重低于5%（n = 42，瘦患者）或超重超过40%（n = 25，肥胖患者）。瘦的临界高血压患者心输出量更大（p < 0.05）、心率更快（p < 0.01）、肾血流量更多（p < 0.05）；血管内容量发生心肺再分布（p < 0.05）；循环去甲肾上腺素水平更高（p < 0.05）。肥胖的血压正常者也表现出心输出量增加（p < 0.005）、每搏输出量增加（p < 0.01）、左心室每搏功增加（p < 0.05）和肾血流量增加（p < 0.05）（但相应指标未增加），但血管内容量增加（p < 0.05）且无再分布，循环儿茶酚胺水平正常。肥胖的临界高血压患者除外周阻力增加（p < 0.05）外，血流动力学特征与肥胖的血压正常者相似。数据表明，虽然这两组人群的心输出量均增加，但瘦的临界高血压患者有肾上腺素能活性增强的迹象，表现为循环儿茶酚胺水平和心率升高，且血容量向心肺循环转移。相比之下，肥胖受试者（无论血压正常还是临界高血压）的心输出量也增加，但其肾上腺素能活性似乎正常，血管内容量增加且无心肺再分布。
