Hypertension, Vol 12, 227-237, Copyright © 1988 by American Heart Association
G Grassi, C Giannattasio, J Cleroux, C Cuspidi, L Sampieri, GB Bolla and G Mancia
Studies that have examined the cardiopulmonary receptor control of
circulation in hypertension have produced conflicting results. In 10
normotensive subjects and in age-matched essential hypertensive subjects
without (n = 10) or with left ventricular hypertrophy (n = 12), as well as
in seven subjects of the latter group restudied after 1 year of treatment
that induced regression of cardiac hypertrophy, we examined the
cardiopulmonary reflex by increasing central venous pressure and
stimulating cardiopulmonary receptors through passive leg raising and by
reducing central venous pressure and deactivating cardiopulmonary receptors
through nonhypotensive lower body negative pressure. Reflex responses were
measured as changes in forearm vascular resistance (mean blood pressure
divided by plethysmographically measured blood flow), plasma norepinephrine
concentration, and plasma renin activity. In hypertensive subjects without
left ventricular hypertrophy, stimulation and deactivation of
cardiopulmonary receptors caused changes in forearm vascular resistance,
norepinephrine concentration, and plasma renin activity that were modestly
reduced as compared with those in normotensive subjects. However, all these
changes were markedly reduced in hypertensive subjects with left
ventricular hypertrophy. Following regression of left ventricular
hypertrophy, the changes in vascular resistance, plasma norepinephrine, and
plasma renin activity induced by cardiopulmonary receptor manipulation all
improved markedly. These results demonstrate that cardiopulmonary receptor
regulation of peripheral vascular resistance and of neurohumoral variables
is impaired in essential hypertension and that the impairment is much more
pronounced when this condition is associated with cardiac structural
alterations. Therapeutic regression of these alterations, however, leads to
a marked improvement of this reflex, with consequent favorable effects on
circulatory homeostasis.
ARTICLES
Cardiopulmonary reflex before and after regression of left ventricular hypertrophy in essential hypertension
Cattedra di Semeiotica Medica, Universita di Milano, Italy.
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