ArticleHypertension (Dallas, Tex. : 1979)2015
Refractory Hypertension: Evidence of Heightened Sympathetic Activity as a Cause of Antihypertensive Treatment Failure.
Article in Hypertension (Dallas, Tex. : 1979), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 66 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Association Between Enhanced Sympathetic Activity and Cardiometabolic Complications: a Cross-sectional Study on Predictive Power of 24-hour Urinary Metanephrines (SYMPACT)
Resistant Hypertension An Open, Complicated ("Cum Plicare") or Complex ("Cum Plexus")
Who cites it
66 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Relationship between lead exposure and different types of hypertension: systematic review and dose-response meta-analysis.Frontiers in public health · 2025Pooled it
- Effects of acute carotid baroreceptor stimulation on sympathetic nerve traffic in resistant and uncontrolled hypertension: a systematic review and meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2024Pooled it
- Refractory Hypertension: a Narrative Systematic Review with Emphasis on Prognosis.Current hypertension reports · 2022Pooled it
- Sequential nephron blockade vs. sequential renin-angiotensin system blockade on central and ambulatory blood pressure in resistant hypertension: A randomized clinical trial.British journal of clinical pharmacology · 2026Trial
- Modulating Oxidative Stress and Inflammation in Elders: The MOXIE Study.Journal of nutrition in gerontology and geriatricsTrial
- Harmonic Analysis of Electrical Activity of the Autonomic Nervous System in Dorsal Perirenal Lumbar Regions in Healthy Volunteers and Patients with Arterial Hypertension.Bulletin of experimental biology and medicine · 2026Article
- Dysregulated neuroendocrine stress response and blood pressure management burden are linked to remote diffusion-weighted imaging lesions after intracerebral hemorrhage: a prospective pilot study.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Trends in the prevalence of apparent treatment-resistant hypertension among U.S. adults, 1999-2018.American journal of preventive cardiology · 2025Article
- Brazilian Guidelines of Hypertension - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Could Renal Vascular Variations Be Associated with Resistant Hypertension? A Single-Center Study.Journal of clinical medicine · 2025Article
- Advances on the Experimental Research in Resistant Hypertension.Current hypertension reports · 2024Review
- Prevalence, Clinical Characteristics, and Treatment of Patients with Resistant Hypertension: A Single-Center Study.Journal of cardiovascular development and disease · 2024Article
- Opportunities and Limitations of Renal Denervation: Where Do We Stand?The American journal of medicine · 2024Review
- Sympathetic overactivity and nocturnal diuresis in obstructive sleep apnea alter the response to hypertension therapy.Clinical hypertension · 2024Article
- A Review of the Risk Factors and Management of Refractory Hypertension: The Role of Carotid Sinus Stimulation and Renal Nerve Denervation.Journal of community hospital internal medicine perspectives · 2024Review
- The Global Burden of Resistant Hypertension and Potential Treatment Options.European cardiology · 2024Review
- Refractory hypertension and obstructive sleep apnea: a novel relationship.Sleep & breathing = Schlaf & Atmung · 2023Article
- International Consensus Statement on Obstructive Sleep Apnea.International forum of allergy & rhinology · 2023Review
- Therapeutic Drug Monitoring in Arterial Hypertension.Journal of personalized medicine · 2023Article
- Differential effects of renal denervation on skin and muscle sympathetic nerve traffic in resistant and uncontrolled hypertension.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2023Article
6 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
Refractory hypertension is an extreme phenotype of treatment failure defined as uncontrolled blood pressure in spite of ≥5 classes of antihypertensive agents, including chlorthalidone and a mineralocorticoid receptor antagonist. A prospective evaluation of possible mechanisms of refractory hypertension has not been done. The goal of this study was to test for evidence of heightened sympathetic tone as indicated by 24-hour urinary normetanephrine levels, clinic and ambulatory heart rate (HR), HR variability, arterial stiffness as indexed by pulse wave velocity, and systemic vascular resistance compared with patients with controlled resistant hypertension. Forty-four consecutive patients, 15 with refractory and 29 with controlled resistant hypertension, were evaluated prospectively. Refractory hypertensive patients were younger (48±13.3 versus 56.5±14.1 years; P=0.038) and more likely women (80.0 versus 51.9%; P=0.047) compared with patients with controlled resistant hypertension. They also had higher urinary normetanephrine levels (464.4±250.2 versus 309.8±147.6 µg per 24 hours; P=0.03), higher clinic HR (77.8±7.7 versus 68.8±7.6 bpm; P=0.001) and 24-hour ambulatory HR (77.8±7.7 versus 68.8±7.6; P=0.0018), higher pulse wave velocity (11.8±2.2 versus 9.4±1.5 m/s; P=0.009), reduced HR variability (4.48 versus 6.11; P=0.03), and higher systemic vascular resistance (3795±1753 versus 2382±349 dyne·s·cm(5)·m(2); P=0.008). These findings are consistent with heightened sympathetic tone being a major contributor to antihypertensive treatment failure and highlight the need for effective sympatholytic therapies in patients with refractory hypertension.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.