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纳洛酮对轻度原发性高血压患者运动后肌肉交感神经活动、全身及小腿血流动力学和动态血压的影响

Influence of naloxone on muscle sympathetic nerve activity, systemic and calf haemodynamics and ambulatory blood pressure after exercise in mild essential hypertension.

作者信息

Hara K, Floras J S

机构信息

Division of Cardiology, Toronto Hospital, Ontario, Canada.

出版信息

J Hypertens. 1995 Apr;13(4):447-61.

PMID:7629406
Abstract

OBJECTIVE

To determine the effects of prior exercise and naloxone on haemodynamics, muscle sympathetic nerve activity, pituitary hormones and ambulatory blood pressure.

METHODS

We studied 14 mild hypertensive and 14 normotensive subjects on two days. After baseline measurements, subjects were randomly allocated to vehicle or naloxone (0.4 mg/kg) 30 min before 45 min treadmill exercise.

RESULTS

In both groups blood pressure, stroke volume, and calf and total peripheral resistances were lower 1 h after exercise, whereas sympathetic activity was unchanged. In normotensive subjects naloxone abolished this calf vasodilation without altering muscle sympathetic nerve activity, and attenuated these haemodynamic aftereffects of exercise, implying a peripheral opioidergic mechanism. Naloxone had no haemodynamic effect in hypertensive subjects. In normotensives there was an inverse relationship between changes in blood pressure and sympathetic activity after vehicle and exercise. This was transformed by naloxone into a positive relationship (r = 0.69, P < 0.02) similar to that observed in hypertensives after vehicle and exercise. Naloxone did not alter the latter positive relationship. Naloxone altered exercise-induced changes in prolactin and luteinizing hormone, but only in normotensive males. In both groups ambulatory blood pressures and heart rates over 2 h after subjects left the laboratory were higher than the values recorded at baseline or 1 h after exercise, and were unaffected by naloxone.

CONCLUSIONS

The depressor effect of exercise is due to peripheral vasodilation, occurs in the absence of sympathetic withdrawal and is short-lived. Endogenous opioids, activated by running, participate in the haemodynamic, sympathoneural and pituitary hormone aftereffects of exercise in normotensive subjects, whereas in hypertensives these aftereffects of exercise are achieved through non-opioidergic mechanisms. These observations are consistent with the concept that activation of endogenous opioid systems by exercise is impaired in mild hypertension.

摘要

目的

确定先前运动和纳洛酮对血流动力学、肌肉交感神经活动、垂体激素及动态血压的影响。

方法

我们在两天内对14名轻度高血压患者和14名血压正常的受试者进行了研究。在进行基线测量后,受试者在进行45分钟跑步机运动前30分钟被随机分配接受安慰剂或纳洛酮(0.4毫克/千克)。

结果

两组在运动后1小时血压、心输出量、小腿及总外周阻力均降低,而交感神经活动未改变。在血压正常的受试者中,纳洛酮消除了这种小腿血管舒张,而未改变肌肉交感神经活动,并减弱了运动后的这些血流动力学后效应,提示存在外周阿片肽机制。纳洛酮对高血压患者的血流动力学无影响。在血压正常者中,安慰剂和运动后血压变化与交感神经活动呈负相关。纳洛酮将此转变为正相关(r = 0.69,P < 0.02),类似于高血压患者在接受安慰剂和运动后的情况。纳洛酮未改变后者的正相关关系。纳洛酮改变了运动诱导的催乳素和黄体生成素变化,但仅在血压正常的男性中如此。两组受试者离开实验室后2小时内的动态血压和心率均高于基线或运动后1小时记录的值,且不受纳洛酮影响。

结论

运动的降压作用归因于外周血管舒张,在无交感神经抑制的情况下发生且持续时间短暂。跑步激活的内源性阿片肽参与血压正常受试者运动后的血流动力学、交感神经及垂体激素后效应,而高血压患者运动后的这些后效应通过非阿片肽机制实现。这些观察结果与轻度高血压患者运动对内源性阿片肽系统的激活受损这一概念一致。

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