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Neurohumoral and Autonomic Regulation of Blood Pressure

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Pediatric Hypertension

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Abstract

Maintenance of BP requires the coordinated regulation of many components that interact in an interdependent network that ultimately controls the main determinants of BP, cardiac output, peripheral resistance, and blood volume. Neurohumoral and autonomic mechanisms are key components of a complex network. The central nervous system, organized into multiple levels of integrative centers, regulates sympathetic activity and vasopressin release in response to nervous and humoral input. The autonomic system, by means of the efferent sympathetic and parasympathetic pathways, regulates heart rate, vasoconstriction, and activation of the renin-angiotensin-aldosterone system. Humoral components, angiotensin II, aldosterone, and atrial natriuretic peptides regulate vasoconstriction and sodium excretion. Short-term regulation of cardiac output and peripheral resistance is interconnected by autonomic nervous system reflexes with the intervention of baroreceptors. Mid-term control is achieved by the interplay between sympathetic nervous traffic, humoral systems, and the kidney, controlling vascular peripheral resistance and blood volume. The kidney, through both pressure-natriuresis and arteriolar mechanisms, as well as by flow-mediated vasodilatation and myogenic reactivity, participates broadly in the process. Finally, a circadian rhythm of BP levels is regulated by a clock mechanism driven by the suprachiasmatic nucleus, which is stimulated directly by light. Advances in molecular biology techniques and genetic experimental models continue to provide more precise information about these complex networks.

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Abbreviations

ACE1:

Angiotensin-converting enzyme 1

ACE2:

Angiotensin-converting enzyme 2

ACh:

Acetylcholine

ADMA:

Asymmetric dimethylarginine

ALD:

Aldosterone

Ang I:

Angiotensin I

Ang I–7:

Angiotensin 1–7

Ang II:

Angiotensin II

Ang III:

Angiotensin III

Ang IV:

Angiotensin IV

AngIVr:

Angiotensin IV receptor

ANGN:

Angiotensinogen

ANP:

Atrial natriuretic peptide

ANS:

Autonomic nervous system

Apr:

Apelin receptor

AS:

Apelinergic system

AT1r:

AT1-receptor

AT2r:

AT2-receptor

BNP:

Brain natriuretic peptide

BP:

Blood pressure

CNP:

C-type natriuretic peptide

CNS:

Central nervous system

CV:

Circadian variability

CVLM:

Caudal ventrolateral medulla

DMV:

Dorsal motor nucleus of the vagus

eNOS:

Nitric oxide synthase

EP:

Epinephrine

ErB:

Endothelin receptor B

GABA:

Gamma-aminobutyric acid

ILM:

Intermediate lateral medulla

MCA4R:

Melanocortin

MR:

Mineralocorticoid receptor

NA:

Nucleus ambiguus

NEP:

Norepinephrine

NO :

Nitric oxide

NOX:

NADPH oxidase

NPRA :

Natriuretic peptide receptor A

NPRB:

Natriuretic peptide receptor B

NTS:

Nucleus of tractus solitarius

OVLT:

Organum vasculosum of the lamina terminalis

PRR:

Prorenin receptor

PSN:

Parasympathetic nucleus

PVN:

Paraventricular nucleus

RAAS:

Renin-angiotensin-aldosterone system

RGS:

Regulator of G protein signaling

RVLM:

Rostral ventrolateral medulla

SNA:

Sympathetic nervous activity

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Authors and Affiliations

  1. Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain

    Empar Lurbe

  2. CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain

    Empar Lurbe & Josep Redon

  3. Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain

    Josep Redon

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  1. Empar Lurbe
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  2. Josep Redon
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Correspondence to Empar Lurbe .

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Editors and Affiliations

  1. Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA

    Joseph T. Flynn

  2. Massachusetts General Hospital, Boston, MA, USA

    Julie R. Ingelfinger

  3. Johns Hopkins University, Baltimore, MD, USA

    Tammy Brady

Section Editor information

  1. Pediatric Nephrology Unit, MassGeneral Hospital for Children at MGH, Harvard Medical School, Boston, MA, USA

    Julie R. Ingelfinger M.D.

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Lurbe, E., Redon, J. (2022). Neurohumoral and Autonomic Regulation of Blood Pressure. In: Flynn, J.T., Ingelfinger, J.R., Brady, T. (eds) Pediatric Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-31420-4_1-2

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  1. Latest

    Neurohumoral and Autonomic Regulation of Blood Pressure
    Published:
    03 August 2022

    DOI: https://doi.org/10.1007/978-3-319-31420-4_1-2

  2. Original

    Neurohumoral and Autonomic Regulation of Blood Pressure
    Published:
    03 March 2017

    DOI: https://doi.org/10.1007/978-3-319-31420-4_1-1

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