CENTRALLY ACTING ANTIHYPERTENSIVE AGENTS: A NARRATIVE REVIEW
DOI:
https://doi.org/10.33508/jwmj.v8i2.8383Keywords:
Centrally acting antihypertensive agents, Hypertension, Imidazoline receptor agonists, Resistant hypertension, Sympathetic nervous systemAbstract
Hypertension remains a major global health problem and is a leading contributor to cardiovascular morbidity and mortality. Although most patients can be treated effectively with commonly used antihypertensive agents such as diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and beta blockers, some individuals require additional therapeutic options to achieve adequate blood pressure control. Centrally acting antihypertensive agents represent an alternative pharmacological approach that lowers blood pressure by reducing sympathetic nervous system activity through central nervous system pathways. This narrative review aims to summarize the mechanisms of action, clinical applications, adverse effects, and current clinical relevance of centrally acting antihypertensive agents in the management of hypertension. Relevant literature was identified through electronic database searches in PubMed, Scopus, and Google Scholar, focusing on studies published between 2015 and 2025. The reviewed literature indicates that drugs such as methyldopa, clonidine, moxonidine, and rilmenidine exert antihypertensive effects through central sympatholytic mechanisms that reduce peripheral vascular resistance and arterial pressure. Methyldopa continues to play an important role in the management of hypertension during pregnancy because of its long-established safety profile, whereas clonidine and selective imidazoline receptor agonists may be used as additional therapy in resistant hypertension or in conditions associated with increased sympathetic activity. However, the clinical use of these agents is often limited by central nervous system adverse effects and other safety considerations. Therefore, centrally acting antihypertensive agents are generally regarded as complementary therapies that may be useful in selected clinical situations rather than as routine first-line treatments.
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