Interventional approaches for resistant hypertension.

PURPOSE OF REVIEW

The number of Americans with hypertension is growing, and within that group there remain a growing number of patients with resistant hypertension. This growth has occurred despite numerous pharmacologic advancements and innovative therapies. Resistant hypertension carries a significant risk of morbidity and mortality. An interventional approach to treating patients with resistant hypertension may provide a supplementary aid to those with difficult-to-control blood pressure on medications alone.

RECENT FINDINGS

An interventional approach to patients with resistant hypertension is effective and likely well tolerated. Baroreceptor stimulation was shown to increase the likelihood of reaching a normal blood pressure in patients whose hypertension was previously uncontrolled using pharmacotherapy alone. Renal sympathetic denervation was likewise shown to successfully treat hypertension in a previously uncontrolled population. With both of these therapies, statistically significant endpoints were reached, and there were likely low risks of procedural complications, though further investigation continues to examine safety and effectiveness.

SUMMARY

Interventional therapies may be an increasingly important adjunct therapy for patients with resistant hypertension that fails to be controlled with pharmacotherapy alone. Two exciting interventions that are under investigation and are likely effective are electrical stimulation of carotid baroreceptors and catheter denervation of renal sympathetic nerves.