Sympathetic neural mechanisms in human blood pressure regulation

Sympathetic neural function is essential to human blood pressure regulation, and overactivity of sympathetic nerves may have an important role in the development of hypertension and related cardiovascular disorders. Importantly, there is extensive interindividual variability in sympathetic vasoconstrictor nerve activity, even among healthy, young, normotensive people. Therefore, the relevance of each person's level of sympathetic nerve activity for his or her blood pressure must be evaluated in the context of other factors contributing to the overall level of blood pressure, including cardiac output and vascular adrenergic responsiveness. We include evidence showing that the balance of factors contributing to normal blood pressure in young people is influenced by sex. Hypertension itself can be multifactorial, but it is often associated with elevated sympathetic nerve activity, which can be reversed by some pharmacologic antihypertensive treatments. Although much work remains to be done in this area, an appropriate recognition of the complexity of integrated physiological regulation and of the importance of interindividual variability will be key factors in moving forward to even better understanding and treatment.