Key result
Drug-resistant hypertension exhibits significantly greater sustained sympathetic overdrive than non-resistant hypertension.
Why the study?
Whether drug-resistant hypertension is characterized by sympathetic activation and whether its magnitude and underlying pathophysiological mechanisms differ from non-resistant hypertension was undefined.
Does the resistant hypertensive phenotype exhibit greater sympathetic overactivation (measured by MSNA) compared to non-resistant hypertension?
Meta-Analysis (n=508)
Does the resistant hypertensive phenotype exhibit greater sympathetic overactivation (measured by MSNA) compared to non-resistant hypertension?
p-value: p=<0.001
Resistant hypertension is associated with marked sympathetic overactivation that is significantly greater than in non-resistant hypertension and cannot be accurately reflected by heart rate or norepinephrine levels.
Sympathetic overdrive merits consideration in resistant hypertension evaluation; extends adrenergic activation evidence from non-resistant to resistant cases.
BACKGROUND: Indirect and direct approaches to assess sympathetic cardiovascular drive have shown that patients with essential hypertension responsive to the blood pressure-lowering effects of antihypertensive drugs are characterized by a pronounced adrenergic overactivity. Whether an emerging clinical hypertensive phenotype such as drug-resistant hypertension (RHT) is also characterized by sympathetic activation and whether its magnitude and underlying pathophysiological mechanisms differ from those of non-RHT is undefined. METHODS: Among the 54 studies identified providing information in RHT on muscle sympathetic nerve traffic (MSNA), 12 were eligible (508 patients) and meta-analyzed, grouping them based on clinically relevant questions: (1) Is MSNA increased in RHT? (2) Does the magnitude of the sympathetic activation differ from that observed in non-RHT? (3) Are heart rate and plasma norepinephrine valuable surrogate markers of MSNA in RHT? and (4) Is baroreflex-MSNA control impaired? RESULTS: <0.001), despite the greater number of antihypertensive drugs. At variance from non-RHT, in RHT, elevated MSNA was unrelated to heart rate and plasma venous norepinephrine. Similar to non-RHT, MSNA in RHT was inversely related to the baroreflex function. CONCLUSIONS: RHT is characterized by a sustained sympathetic overdrive, significantly greater in magnitude than the 1 detected in non-RHT. Neither heart rate nor norepinephrine are capable of reflecting the marked adrenergic overdrive seen in this condition via MSNA recordings.
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Grassı et al. (2025) conducted a meta-analysis in Drug-resistant hypertension (RHT) (n=508). Drug-resistant hypertension (RHT) vs. Non-resistant hypertension (non-RHT) was evaluated on Muscle sympathetic nerve traffic (MSNA) (p=<0.001). Drug-resistant hypertension is characterized by a sustained sympathetic overdrive significantly greater in magnitude than in non-resistant hypertension (P<0.001).
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