科研之友
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摘要
Objective: Previous studies have shown that blood pressure assessment by a nurse markedly attenuates the pressor and tachicardic responses triggered by the physician blood pressure measurement. Whether and to what extent this attenuation reflects a different pattern of the neuroadrenergic responses to doctor or nurse blood pressure evaluation is unknown. %26lt;br%26gt;Methods: In 19 lean untreated mild essential hypertensive patients (age 39.1 +/- 2.4 years, mean +/- SEM), we measured beat-to-beat mean arterial pressure (Finapres), heart rate (ECG), and efferent postganglionic muscle and skin sympathetic nerve traffic [muscle sympathetic nerve activity (MSNA) and skin sympathetic nerve activity (SSNA), respectively, by microneurography], before, during, and following a 10-min sphygmomanometric BP measurement by a doctor or by a nurse unfamiliar to the patients. Measurements were repeated at a 30-min interval to obtain, in separate periods, muscle and skin sympathetic nerve traffic recordings. Both the sequences (doctor vs. nurse and muscle vs. skin sympathetic nerve traffic) were randomized. %26lt;br%26gt;Results: A doctor visit induced sudden, marked, and prolonged blood pressure and heart rate increases, accompanied by a muscle sympathetic nerve traffic inhibition (average response: -18.1 +/- 4.3%, P%26lt;0.01) coupled with a skin sympathetic nerve traffic excitation (average response: +46.1 +/- 5.5%, P%26lt;0.01). In contrast, a nurse visit elicited blood pressure and heart rate responses markedly and significantly reduced (=72.1 +/- 11 and -81.7 +/- 13% respectively, P%26lt;0.01) as compared with those seen during the doctor%26apos;s visit. This was the case also for muscle and skin sympathetic neural responses (-44.3 +/- 9 and -65.6 +/- 13%, P%26lt;0.01). %26lt;br%26gt;Conclusion: These data provide the first evidence that the blunted pressor and tachicardic responses to nurse%26apos;s blood pressure measurements are accompanied by an attenuation of the adrenergic neural responses seen during the alerting reaction accompanying doctor%26apos;s blood pressure measurement.
- 出版日期2013-6
