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Recent advances in the pathophysiology of arterial hypertension: potential implications for clinical practice
Insights
Resistant hypertension (RH) affects over 10% of patients. New therapies targeting the sympathetic nervous system show promise for controlling blood pressure (BP) by modulating neural reflexes.
Area of Science:
- Cardiology
- Neuroscience
- Public Health
Background:
- Hypertension is a major global health issue linked to cardiovascular disease.
- Resistant hypertension (RH), affecting 10.1% of patients, involves complex mechanisms.
- Sympathetic nervous system activation is heightened in RH, contributing to its progression.
Purpose of the Study:
- To review the role of the central sympathetic nervous system in hypertension.
- To discuss novel therapeutic strategies targeting neural reflex mechanisms in RH.
- To explore future research directions for managing uncontrolled hypertension.
Main Methods:
- Review of existing literature on resistant hypertension.
- Analysis of therapeutic interventions targeting neural pathways.
- Discussion of recent findings on vasopressinergic neurons and brain neural activity.
Main Results:
- Sympathetic overactivity is a key factor in resistant hypertension.
- Various neuro-modulating therapies (e.g., renal denervation) offer potential BP reduction.
- Variable responses highlight the need for personalized treatment strategies.
Conclusions:
- Targeting centrally mediated sympathetic pathways offers a novel approach to managing resistant hypertension.
- Further research is needed to identify predictors of treatment response and refine therapies.
- Understanding impaired neural reflexes is crucial for advancing hypertension management.
Abstract:
Hypertension remains a major and growing public health problem associated with the greatest global rate of cardiovascular morbidity and mortality. Although numerous factors contribute to poor control of blood pressure (BP) and to pseudoresistance (eg, unawareness, lifestyle habits, nonadherence to medication, insufficient treatment, drug‑induced hypertension, undiagnosed secondary causes), true resistant hypertension (RH) is reported in 10.1% of patients treated for elevated BP. While the mechanisms underlying RH remain complex and not entirely understood, sympathetic activation involved in the pathophysiology of hypertension, disease progression, and adverse complications is further augmented in patients with drug‑resistant hypertension. The well‑established contribution of neurogenic component of hypertension has led to the introduction of new alternative therapies aimed specifically at modulating central and neural reflexes mechanisms involved in BP control. Although clinical benefits of lowering BP with renal denervation, baroreflex activation therapy, carotid body denervation, central arteriovenous anastomosis, and deep brain stimulation have advanced our knowledge on uncontrolled hypertension, the variable BP response has prompted extensive ongoing research to define predictors of treatment effectiveness and further investigation of pathophysiology of RH. Very recently, research on the role of vasopressinergic neurons, masked tachycardia, and impaired brain neural activity has provided novel insights into hypertension. This review briefly summarizes the role of the centrally mediated sympathetic nervous system in hypertension, the therapeutic strategies that distinctively target impaired neural reflex mechanisms, and potential implications for future clinical research and therapies.