Stress-induced and resistant arterial hypertension: the pathophysiological role of sympathetic overactivity and the place of moxonidine in contemporary therapeutic strategies

Zavhorodnia O.L.

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Stress-induced and resistant arterial hypertension: the pathophysiological role of sympathetic overactivity and the place of moxonidine in contemporary therapeutic strategies

October 22, 2026

Zavhorodnia O.L.

УДК: УДК 616.12-008.331.1:616.89-008.44

DOI: 10.32471/umj.1680-3051.281742<тт/a>

Keywords :

arterial hypertension,

resistant hypertension,

sympathetic overactivity,

treatment adherence

Resume

Abstract. This article provides a comprehensive analysis of the management of stress-induced and resistant arterial hypertension in the context of prolonged psychological and emotional distress. It examines the role of persistent sympathetic nervous system overactivity as a key driver of hypertension pathophysiology, contributing to adverse 24-hour blood pressure patterns, including non-dipping and nocturnal blood pressure elevation (night-peaking), and perpetuating a vicious cycle associated with metabolic syndrome.
In light of the stringent recommendations of the 2024 European Society of Cardiology (ESC) Guidelines regarding the achievement of a target systolic blood pressure (BP) of <130 mmHg, the need to address the residual neurogenic component of hypertension is substantiated. The clinical role of moxonidine, a selective imidazoline I₁ receptor agonist, is defined as an add-on therapeutic option when standard antihypertensive regimens fail to achieve optimal BP control. Three key patient phenotypes that may derive pathophysiological and clinical benefit from this treatment are identified: stress-induced hypertension accompanied by nocturnal hypertension, metabolic syndrome with abdominal obesity, and hypertension associated with concomitant endocrine disorders.
The safety criteria for treatment are analyzed in detail, with particular emphasis on the contraindication to moxonidine use in patients with heart failure, based on evidence from the MOXCON trial. A clinical decision-making algorithm is presented to guide physicians in excluding pseudoresistant hypertension, obstructive sleep apnea, and renovascular disease. Particular attention is also given to long-term treatment adherence, which may be facilitated by the availability of affordable, quality-assured generic medications manufactured in Ukraine, including moxonidine tablets containing 0.2 mg and 0.4 mg produced by JSC Lubnypharm, particularly under conditions of sustained societal stress.

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