Noll G, Wenzel R R, Binggeli C, Corti C, Lüscher T F
Cardiology, University Hospital Zürich, Switzerland.
Eur Heart J. 1998 Jun;19 Suppl F:F32-8.
The sympathetic nervous system (SNS) plays an important role in the regulation of cardiac performance and peripheral circulation. Changes in SNS activity measured as catecholamines in plasma or organ spillover have been implicated in the pathogenesis of hypertension. Recent studies using microneurography to directly assess peripheral sympathetic nerve activity have demonstrated an increase in sympathetic activity in patients with borderline hypertension at rest and during hypoxia. We have recently shown that resting muscle sympathetic nerve activity is comparable in offspring of hypertensive and normotensive parents. However, during mental arithmetic the increase in muscle sympathetic nerve activity and blood pressure was significantly more pronounced in offspring of hypertensive than in offspring of normotensive parents, but resting blood pressure was in the normotensive range and comparable in both groups. These data indicate that the response to mental stress results in a more pronounced activation of SNS in normotensive subjects with a genetic background of hypertension. In other cardiovascular disease states such as acute myocardial infarction and heart failure activity of the SNS may determine prognosis significantly. Some calcium antagonists which are successfully used to treat patients with hypertension and stable angina pectoris may have unfavourable effects in patients with impaired left ventricular function. This could be due in part to baroreceptor-mediated activation of the SNS, an effect which seems to be related to pharmacokinetics and pharmacodynamics of the drugs. In contrast, angiotensin converting enzyme inhibitors seem to directly decrease sympathetic nerve activity. This may explain at least in part their beneficial effects in patients with impaired left ventricular function. Thus, the SNS as a regulator of the cardiovascular system also plays an important role in the pathophysiology of cardiovascular diseases such as hypertension, myocardial infarction and heart failure. Furthermore, drug therapy could have a significant impact on the activity of the SNS.
交感神经系统（SNS）在心脏功能和外周循环的调节中发挥着重要作用。以血浆或器官中儿茶酚胺水平衡量的SNS活性变化与高血压的发病机制有关。最近使用微神经ography直接评估外周交感神经活动的研究表明，临界高血压患者在静息和低氧状态下交感神经活动增加。我们最近发现，高血压和正常血压父母的后代静息肌肉交感神经活动相当。然而，在进行心算时，高血压父母的后代肌肉交感神经活动和血压的增加明显比正常血压父母的后代更显著，但静息血压处于正常血压范围内，两组相当。这些数据表明，对精神应激的反应导致具有高血压遗传背景的正常血压受试者的SNS激活更为明显。在其他心血管疾病状态下，如急性心肌梗死和心力衰竭，SNS的活动可能对预后有显著影响。一些成功用于治疗高血压和稳定型心绞痛患者的钙拮抗剂可能对左心室功能受损的患者有不利影响。这可能部分归因于压力感受器介导的SNS激活，这种效应似乎与药物的药代动力学和药效学有关。相比之下，血管紧张素转换酶抑制剂似乎直接降低交感神经活动。这至少可以部分解释它们对左心室功能受损患者的有益作用。因此，SNS作为心血管系统的调节器，在高血压、心肌梗死和心力衰竭等心血管疾病的病理生理学中也起着重要作用。此外，药物治疗可能对SNS的活动产生重大影响。
