Fig. 10.1
Summary of sex differences in neural regions of cardiovascular regulation. SFO projections stimulate sympathoexcitatory PVN projections to the IML, as well as indirect projections (dashed line) via the RVLM. The baroreceptor reflex comprises NTS projections to sympathoexcitatory neurons of the RVLM via the CVLM, which in turn project to the IML. ERα (red) is predominant in the SFO and NTS, while ERβ is more common in the PVN and RVLM. Sympathoexcitatory projections from these latter regions to the IML contain ERβ (purple). Baseline sex differences in several brain regions critical for blood pressure regulation involve estrogen receptors anatomically poised to influence pressor responses. In addition, circulating estrogens can affect a variety of regulatory mechanisms
5.2 Conclusions
Understanding the mechanisms underlying sex differences in the neural regulation of blood pressure is critical for new therapies and treatments. Hypertensive therapies for menopausal women are crucial for reducing cardiovascular disease risk since standard treatments are often not sufficient for reducing blood pressure in women, and reduction thresholds may be different in women [150]. Indeed, organizational differences in cardiovascular brain regions between males and females may have important treatment implications following decreased ovarian hormone levels. The protective actions of estrogens from neurovascular-associated diseases such as stroke and AD may be due as much to their prevention of cerebrovascular dysfunction as to any neuroprotection estrogens provide following disease onset. Furthermore, a firm understanding of the role of ovarian hormones in these neural pathways regulating blood pressure will be crucial to developing HRT that is both safe and effective. The role of ovarian hormones in neural regulation of blood pressure may also influence our understanding and treatment of hypertension associated with polycystic ovarian syndrome, during pregnancy, or even in treatment-resistant hypertension in men.
Acknowledgment
Grant Support: NIH grants DA08259, HL098351 (TAM), HL096571 (MJG & TAM), T32 DA007274 (TVK).
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