Creager M A, Creager S J
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115.
J Am Coll Cardiol. 1994 Feb;23(2):401-5. doi: 10.1016/0735-1097(94)90427-8.
This study was designed to determine whether arterial baroreflex control of blood pressure is altered in patients with congestive heart failure.
Arterial baroreceptor reflexes normally contribute to cardiovascular homeostasis by preserving blood pressure during changes in volume and posture.
Arterial baroreceptor reflex function was studied in 18 patients with congestive heart failure and 18 age-matched healthy subjects. The arterial baroreceptor-blood pressure reflex was assessed by measuring the blood pressure response to perturbations in carotid sinus pressure. Carotid baroreceptors were stimulated by applying negative pressure to a custom neck chamber (-10, -20 and -30 mm Hg) and were unloaded by applying neck positive pressure (+10, +20 and +30 mm Hg).
Peak carotid baroreceptor-blood pressure reflex sensitivity was lower in patients with heart failure than in normal subjects (0.19 +/- 0.02 vs. 0.30 +/- 0.03 mm Hg/mm Hg, p < 0.05). During neck positive pressure, blood pressure increased less in the heart failure group than in the normal group. During neck suction, however, the decrease in blood pressure was similar in the two groups.
Patients with heart failure are less able than normal subjects to increase blood pressure during arterial baroreceptor unloading, but they can reduce blood pressure appropriately during baroreceptor stimulation. These observations suggest that the resting blood pressure position on the arterial baroreceptor stimulus-response curve, the operational point, is closer to the baroreceptor threshold in patients with heart failure than in normal subjects. As a result, reduced inhibitory signals from arterial baroreceptors most likely contribute to a heightened state of sympathetic activity and vasoconstriction in patients with congestive heart failure.
本研究旨在确定充血性心力衰竭患者的动脉压力感受器对血压的控制是否发生改变。
动脉压力感受器反射通常通过在容量和姿势变化时维持血压来促进心血管稳态。
对18例充血性心力衰竭患者和18例年龄匹配的健康受试者进行动脉压力感受器反射功能研究。通过测量对颈动脉窦压力扰动的血压反应来评估动脉压力感受器-血压反射。通过向定制的颈部腔室施加负压（-10、-20和-30mmHg）刺激颈动脉压力感受器，并通过施加颈部正压（+10、+20和+30mmHg）使其卸载。
心力衰竭患者的颈动脉压力感受器-血压反射峰值敏感性低于正常受试者（0.19±0.02对0.30±0.03mmHg/mmHg，p<0.05）。在颈部正压期间，心力衰竭组的血压升高幅度小于正常组。然而，在颈部抽吸期间，两组的血压下降幅度相似。
与正常受试者相比，心力衰竭患者在动脉压力感受器卸载时升高血压的能力较弱，但在压力感受器刺激时能够适当降低血压。这些观察结果表明，心力衰竭患者在动脉压力感受器刺激-反应曲线上的静息血压位置（即工作点）比正常受试者更接近压力感受器阈值。因此，来自动脉压力感受器的抑制信号减少很可能导致充血性心力衰竭患者交感神经活动增强和血管收缩。
