Rubio Tatiane de Azevedo, Godoy Moacir Fernandes de, Uyemura Jéssica Roma Rodrigues, Tanus-Santos José E, Minari Tatiana Palotta, Vilela-Martin José Fernando, Yugar-Toledo Juan Carlos, Moreno Junior Heitor
Faculty of Medical Sciences - State University of Campinas, Campinas, Brazil.
Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, Brazil.
J Hum Hypertens. 2025 May 23. doi: 10.1038/s41371-025-01028-2.
Resistant arterial hypertension (RHTN) has been associated with sympathetic hyperactivity, which represents a significant challenge in the management and treatment of arterial hypertension. In the present study, autonomic modulation was analysed in hypertensive, resistant hypertensive, and refractory hypertensive patients, compared to a group of apparently healthy normotensive individuals. Participants with resistant hypertension were included only after the exclusion of secondary hypertension and pseudo-resistance diagnoses. Heart rate variability (HRV) analysis included parameters from the time domain, frequency domain, and nonlinear methods, providing a comprehensive assessment of global autonomic modulation. The results demonstrated a significant reduction in global HRV across all three hypertensive groups, evidenced by decreases in parameters from the time domain, frequency domain and nonlinear methods. Furthermore, a concomitant reduction in the low- and high-frequency components was observed, with the decrease in the high-frequency component being more pronounced. These findings challenge the traditional view of isolated sympathetic hyperactivity in hypertension. Instead, the results reveal a relative predominance of sympathetic function due to the more marked attenuation of parasympathetic activity. These results underscore the need to reinterpret autonomic dysfunction in arterial hypertension, particularly in its more severe forms, as a global loss of autonomic modulation.
顽固性动脉高血压（RHTN）与交感神经过度活跃有关，这在动脉高血压的管理和治疗中是一个重大挑战。在本研究中，对高血压患者、顽固性高血压患者和难治性高血压患者的自主神经调节进行了分析，并与一组明显健康的血压正常个体进行了比较。仅在排除继发性高血压和假性顽固性诊断后，才纳入顽固性高血压患者。心率变异性（HRV）分析包括时域、频域和非线性方法的参数，从而对整体自主神经调节进行全面评估。结果表明，所有三个高血压组的整体HRV均显著降低，这在时域、频域和非线性方法的参数降低中得到了证实。此外，观察到低频和高频成分同时降低，高频成分的降低更为明显。这些发现挑战了高血压中孤立性交感神经过度活跃的传统观点。相反，结果显示由于副交感神经活动的更明显减弱，交感神经功能相对占优势。这些结果强调，需要将动脉高血压，特别是其更严重形式中的自主神经功能障碍重新解释为自主神经调节的整体丧失。
