Introduction: Hypertension is the most common ca-use of development of phenotypic spectrum of heart failure with preserved ejection fraction. N-terminal pro-brain natriuretic peptide, in these condition, repre-sent a pathophysiologic marker with prognostic value in evolution and treatment strategy. Thus, we aimed to evaluate the plasma level of N-terminal pro–brain na-triuretic peptide in patients with resistant hypertension under the influence of long-term medication with sym-pathetic nervous system blockers.

Methods: 100 patients with essential HTN gr.3 and heart failure with preserved ejection fraction (HFpEF), without comorbidities, after a 3-week treatment with standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized in two groups, depending on the me-dication supplemented to the previously administered: group I (M) – selective I1-imidazoline agonist Moxo-nidine and group II (B) – cardioselective beta-blocker Bisoprolol. The plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were ≥125 pg/mL for all patients. Assessment of NT-proBNP were perfor-med at baseline, six and twelve months follow-up.

Results: Significant reduction of NT-proBNP levels was already noted from the 6th month of continued medication in both treatment groups, demonstrating a reduction of – 64.8 ± 25.0 pg / mL in group I versus -134.5 ± 28.6 pg / mL in group II, p<0.001. Normaliza-tion of this parameter in the observation group II was recorded at 12 months, averaging 120.8 ± 20.4 pg / mL. Administration of both treatment regimens signifi-cantly reduced the level of NTpro-BNP in patients with resistant HTN, but Bisoprolol demonstrated a superior efficacy to Moxonidine with the normalization of this parameter at 12 months of continuous medication.

Conclusions: Long-term treatment with SNS blockers demonstrated a statistically significant improvement in NT-proBNP plasma level with a superior potency of Bisoprolol in patients with resistant HTN and HFpEF.