Munakata M, Imai Y, Hashimoto J, Omata K, Nakao M, Yamamoto M, Abe K
Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
J Auton Nerv Syst. 1995 Apr 8;52(2-3):213-23. doi: 10.1016/0165-1838(94)00159-h.
The role of the autonomic nervous system in hypertension due to mineralocorticoid excess remains unclear. To address this issue, we performed power spectral analysis of blood pressure (BP) and RR interval oscillations in 20 patients with primary aldosteronism (PA), 54 patients with essential hypertension (EH) and 45 normotensive (NT) subjects. Blood pressure and the degree of organ damage were similar between PA and EH groups. Age did not differ between the three groups. The Mayer wave power spectrum (MWP) of BP (approx. 0.1 Hz), an index of sympathetic vasomotor tone, was smaller in patients with PA than in patients with EH either while subjects were supine (systolic/diastolic; 3.9 +/- 3.2 (SD)/1.5 +/- 1.3 vs. 5.5 +/- 4.2/2.1 +/- 1.6 mmHg2, P < 0.05 for both) or standing (7.6 +/- 6.6/3.0 +/- 3.0 vs. 17.7 +/- 23.7/7.2 +/- 8.3 mmHg2, P < 0.05 for both). Supine respiratory-related power spectrum (RRP) of the RR interval (approx. 0.25 Hz), an index of cardiac parasympathetic tone, was greater in patients with PA than in patients with EH (545 +/- 574 vs. 302 +/- 464 ms2, P < 0.01). The MWP of BP and the RRP of the RR interval were similar between patients with PA and NT subjects. Adrenalectomy reduced the 24-h mean BP (-18 mmHg for systolic BP, P < 0.001; -12 mmHg for diastolic BP, P < 0.01) and increased the 24-h mean heart rate (+8 bpm, P < 0.001). Furthermore, the diastolic MWP increased mildly (+32%, P < 0.05) and the RRP of the RR interval decreased dramatically (-75%, P < 0.01) following adrenalectomy. These results suggest that both vascular sympathetic and cardiac parasympathetic regulatory systems have minor roles in the maintenance of hypertension in patients with PA. The autonomic nervous system contributes more to the maintenance of BP following than prior to adrenalectomy. This information may be useful for the management of hypertension still persists after removal of adrenal adenoma.
盐皮质激素过多所致高血压中自主神经系统的作用仍不清楚。为解决这一问题，我们对20例原发性醛固酮增多症（PA）患者、54例原发性高血压（EH）患者和45例血压正常（NT）受试者进行了血压（BP）和RR间期振荡的功率谱分析。PA组和EH组的血压及器官损害程度相似。三组年龄无差异。作为交感血管运动张力指标的BP的迈尔波功率谱（MWP，约0.1Hz），在PA患者中比EH患者小，无论是受试者仰卧时（收缩压/舒张压；3.9±3.2（标准差）/1.5±1.3 vs. 5.5±4.2/2.1±1.6mmHg²，两者P<0.05）还是站立时（7.6±6.6/3.0±3.0 vs. 17.7±23.7/7.2±8.3mmHg²，两者P<0.05）。作为心脏副交感神经张力指标的RR间期的仰卧呼吸相关功率谱（RRP，约0.25Hz），PA患者比EH患者大（545±574 vs. 302±464ms²，P<0.01）。PA患者与NT受试者的BP的MWP和RR间期的RRP相似。肾上腺切除术降低了24小时平均血压（收缩压降低18mmHg，P<0.001；舒张压降低12mmHg，P<0.01）并增加了24小时平均心率（增加8次/分钟，P<0.001）。此外，肾上腺切除术后舒张压MWP轻度增加（+32%，P<0.05），RR间期的RRP显著降低（-75%，P<0.01）。这些结果表明，血管交感神经和心脏副交感神经调节系统在PA患者高血压维持中作用较小。自主神经系统在肾上腺切除术后对血压维持的作用比术前更大。这一信息可能对肾上腺腺瘤切除后仍持续存在的高血压的管理有用。
