Autonomic mechanisms of blood pressure control in females across the lifespan

This review summarizes current knowledge on autonomic cardiovascular function, with a focus on sympathetic neural control, in human females across the lifespan in health and disease. Specifically, sympathetic activity at rest and during stressors, sympathetic transduction into vascular resistance or blood pressure, and baroreflex sensitivity under physiological conditions (e.g., the menstrual cycle, oral contraceptives, pregnancy, and menopause) are reviewed. Furthermore, how sympathetic neural control is influenced by pathological conditions that only affect females (e.g., polycystic ovarian syndrome and hypertensive disorders of pregnancy) or that affect a large proportion of females (e.g., postural orthostatic tachycardia syndrome, hypertension, and heart failure with preserved ejection fraction) are also reviewed. Generally, augmented sympathetic activity, blunted sympathetic transduction, and reduced baroreflex sensitivity are associated with disease state. Pregnancy might be the only healthy state that is linked with sympathetic activation. Despite advancements in knowledge over the past 30 years, significant research gaps persist in neural control in females, especially around perimenopause.