Blood pressure is regulated by vascular resistance and intravascular volume. However, exchanges of electrolytes and water between intra and extracellular spaces and filtration of fluid and solutes in the capillary beds blur the separation between intravascular, interstitial and intracellular compartments. Contemporary paradigms of microvascular exchange posit filtration of fluids and solutes along the whole capillary bed and a prominent role of lymphatic vessels, rather than its venous end, for their reabsorption. In the last decade, these concepts have stimulated greater interest in and better understanding of the lymphatic system as one of the master regulators of interstitial volume homeostasis. Here, we describe the anatomy and function of the lymphatic system and focus on its plasticity in relation to the accumulation of interstitial sodium in hypertension. The pathophysiological relevance of the lymphatic system is exemplified in the kidneys, which are crucially involved in the control of blood pressure, but also hypertension-mediated cardiac damage. Preclinical modulation of the lymphatic reserve for tissue drainage has demonstrated promise, but has also generated conflicting results. A better understanding of the hydraulic element of hypertension and the role of lymphatics in maintaining fluid balance can open new approaches to prevent and treat hypertension and its consequences, such as heart failure.

中文翻译：

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钠、间质、淋巴管和高血压——液压学的故事


血压受血管阻力和血管内容量调节。然而，细胞内外空间之间电解质和水的交换以及毛细血管床中液体和溶质的过滤模糊了血管内、间质和细胞内区室之间的分离。当代微血管交换的范式假定液体和溶质沿着整个毛细血管床进行过滤，并且淋巴管（而不是其静脉端）在其重吸收方面发挥着重要作用。在过去的十年中，这些概念激发了人们对淋巴系统作为间质容量稳态的主要调节器之一的更大兴趣和更好的理解。在这里，我们描述了淋巴系统的解剖结构和功能，并重点关注其与高血压时间质钠积聚相关的可塑性。淋巴系统的病理生理学相关性以肾脏为例，肾脏对于血压的控制以及高血压介导的心脏损伤至关重要。用于组织引流的淋巴储备的临床前调节已被证明有希望，但也产生了相互矛盾的结果。更好地了解高血压的水力因素以及淋巴管在维持液体平衡中的作用可以开辟预防和治疗高血压及其后果（例如心力衰竭）的新方法。