Autonomic control of blood pressure in women: The roles of hypertension and aging

Hypertension remains a leading cause of cardiovascular morbidity and mortality worldwide, with implications in women's health across the lifespan. Of note, autonomic nervous system imbalances have been linked to the development of hypertension and are present with natural aging and various conditions unique to women (e.g., menopause, hypertensive disorders of pregnancy, polycystic ovary syndrome). As such, this article reviews the critical changes in the sympathetic and parasympathetic nervous systems that occur in women and may contribute to the development of hypertension. Special focus is paid to the regulating pathways across the baroreflex arc, including baroreflex sensitivity, efferent sympathetic outflow, and peripheral sympathetic transduction, at rest and during various physiological stressors. To this point, aging women experience increasing sympathetic outflow, blunted sympathetic transduction, and reduced cardiovagal baroreflex sensitivity, which may be further potentiated by the presence of hypertension. Additionally, this review applies some clinical perspective to the physiological findings in order to identify potential therapeutic pathways. The information gathered in this review has important implications for future research into women's autonomic blood pressure regulation and its impact on the genesis of hypertension.