Reserpine Substantially Lowers Blood Pressure in Patients With Refractory Hypertension: A Proof-of-Concept Study

Area of Science:

• Cardiology
• Pharmacology
• Hypertension Research

Background:

• Refractory hypertension (RfHTN) is characterized by uncontrolled blood pressure despite maximal antihypertensive therapy, including chlorthalidone and a mineralocorticoid receptor antagonist.
• Previous research indicates that heightened sympathetic tone may be a key factor in the development of RfHTN.

Purpose of the Study:

• To investigate the efficacy of reserpine, a potent sympatholytic agent, in reducing blood pressure in patients diagnosed with RfHTN.
• To provide further support for the hypothesis that elevated sympathetic nervous system activity contributes to treatment-resistant hypertension.

Main Methods:

• Six patients with confirmed adherence to antihypertensive regimens and suspected RfHTN completed the open-label trial.
• Patients received reserpine 0.1 mg daily for 4 weeks after other sympatholytic medications were discontinued.
• Blood pressure was assessed using automated office blood pressure (AOBP) and 24-hour ambulatory blood pressure (ABP) monitoring at baseline and after treatment.

Main Results:

• Reserpine significantly reduced mean systolic and diastolic AOBP by 29.3/22.0 mm Hg.
• Mean 24-hour, awake, and asleep systolic and diastolic ABPs were all substantially lowered.
• Specific reductions included 21.8/15.3 mm Hg for 24-hour ABP, 23.8/17.8 mm Hg for awake ABP, and 21.5/13.7 mm Hg for asleep ABP.

Conclusions:

• Reserpine demonstrated significant blood pressure-lowering effects in patients with refractory hypertension.
• These findings support the role of excessive sympathetic nervous system output in the pathophysiology of RfHTN.
• Reserpine may be a valuable therapeutic option for managing patients with resistant hypertension.