From the Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca (R.D., F.Q.-T., G.S., F.Z., G.G.).
Istituto di Ricerca a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan (S.B., F.A.).
Hypertension. 2019 Oct;74(4):903-909. doi: 10.1161/HYPERTENSIONAHA.119.13009. Epub 2019 Aug 5.
True drug-resistant hypertension (RHT) is characterized by a marked neuroadrenergic activation and reflex alterations compared with the nonresistant hypertensive state. It is unknown however, whether this behavior is specific for the RHT state or is also shared by apparent RHT (ARHT). In 38 middle-age patients with RHT, 44 treated essential controlled hypertensives (HT) and 32 ARHT; we evaluated sphygmomanometric, beat-to-beat (Finapres) and 24-hour (Spacelabs) blood pressure, heart rate and muscle sympathetic nerve traffic (microneurography). Measurements included plasma aldosterone, plasma norepinephrine, homeostasis model assessment index, and spontaneous baroreflex-muscle sympathetic nerve traffic sensitivity. All the various above-mentioned blood pressure values were significantly greater in both RHT and ARHT as compared with HT, while 24-hour blood pressure was significantly lower in ARHT as compared with RHT. In ARHT, muscle sympathetic nerve traffic was significantly lower than RHT (74.8±5.2 versus 89.2±4.8 bursts/100 hb, <0.01) and similar to HT (69.7±4.8 bursts/100 hb, =NS). RHT showed, at variance from the other 2 groups, greater plasma aldosterone and homeostasis model assessment index values and an impaired baroreflex function. In RHT, but not in ARHT and HT, muscle sympathetic nerve traffic was significantly and inversely related to baroreflex function (=-0.40, <0.02) and directly to plasma aldosterone and homeostasis model assessment index values (=0.34-0.36, <0.05). Plasma norepinephrine and heart rate values were not significantly different in the 3 groups. These data provide evidence that the marked sympathetic activation and baroreflex dysfunction detected in RHT is not present in ARHT, which displays a sympathetic and baroreflex profile superimposable to that seen in HT. These differences in the neurogenic function may have important clinical and therapeutic implications.
真正的药物抵抗性高血压（RHT）的特点是与非抵抗性高血压状态相比，明显的神经递质激活和反射改变。然而，尚不清楚这种行为是 RHT 状态特有的，还是也存在于明显的 RHT（ARHT）中。在 38 名中年 RHT 患者中，44 名接受治疗的原发性高血压患者（HT）和 32 名 ARHT 患者；我们评估了血压计、逐拍（Finapres）和 24 小时（Spacelabs）血压、心率和肌肉交感神经流量（微神经图）。测量包括血浆醛固酮、血浆去甲肾上腺素、稳态模型评估指数和自主血压反射-肌肉交感神经流量敏感性。与 HT 相比，RHT 和 ARHT 的所有上述血压值均显著升高，而 ARHT 的 24 小时血压显著低于 RHT。在 ARHT 中，肌肉交感神经流量明显低于 RHT（74.8±5.2 与 89.2±4.8 爆发/100 hb，<0.01），与 HT 相似（69.7±4.8 爆发/100 hb，=NS）。RHT 显示，与其他 2 组不同，血浆醛固酮和稳态模型评估指数值更高，血压反射功能受损。在 RHT 中，但不是在 ARHT 和 HT 中，肌肉交感神经流量与血压反射功能呈显著负相关（=-0.40，<0.02），与血浆醛固酮和稳态模型评估指数值呈显著正相关（=0.34-0.36，<0.05）。3 组血浆去甲肾上腺素和心率值无显著差异。这些数据提供了证据表明，在 RHT 中检测到的明显的交感神经激活和血压反射功能障碍不存在于 ARHT 中，ARHT 显示的交感神经和血压反射特征与 HT 相似。神经源性功能的这些差异可能具有重要的临床和治疗意义。
