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Recent advances in the pathophysiology of arterial hypertension - potential implications for clinical practice.

Research paper by Dagmara D Hering, Andrzej A Trzebski, Krzysztof K Narkiewicz

Indexed on: 08 Mar '17Published on: 08 Mar '17Published in: Polskie Archiwum Medycyny Wewnetrznej



Abstract

Hypertension remains a major and growing public health problem associated with the greatest proportion of global cardiovascular (CV) morbidity and mortality. Although numerous factors contribute to poor blood pressure (BP) control and pseudo-resistance (i.e. unawareness, life-style habits, non-adherence to medication, insufficient treatment, drug-induced hypertension, undiagnosed secondary causes etc.), it is reported that true resistant hypertension (RH) is found in 10.1 % of patients treated for elevated BP. While the mechanisms underlying RH remain complex and not entirely understood, sympathetic activation that lies in hypertension pathophysiology, disease progression and adverse complications is further augmented in patients with drug-RH. The well-established contribution of neurogenic component of hypertension has led to the introduction of new alternative therapies aimed at specifically modulating central and neural reflexes mechanisms involved in BP control. Although clinical benefits of lowering BP with renal denervation (RDN), baroreflex activation therapy (BAT), carotid body denervation (CBD), central arteriovenous (AV) anastomosis and deep brain stimulation (DBS) have advanced our knowledge in uncontrolled hypertension, the variable BP response has attracted great interest and prompted extensive ongoing research to define predictors of treatment effectiveness and further investigate pathophysiology of RH. Very recently, the role of vasopressinergic neurones, masked tachycardia and impaired brain neural activity has provided novel insights into hypertension disease. 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.