Device-based Therapies for Resistant Hypertension

Rosa      Maria Bruno; Alessia      Di Giulio; Giampaolo      Bernini; Agostino      Virdis; Lorenzo      Ghiadoni; Stefano      Taddei

doi:10.2174/1381612811319130008

Abstract

Hypertension is universally considered the most detrimental among cardiovascular risk factors. Despite the overwhelming evidence of benefits deriving from lowering blood pressure, its control among the hypertensive population is still unsatisfactory. Resistant hypertension has a non negligible prevalence among hypertensive patients, and it is associated with a worse cardiovascular prognosis. There is need of new therapeutic approaches for reducing cardiovascular risk in this population.

Sympathetic nervous system is known to play a major role in development and maintenance of essential hypertension, thus in the past decades several efforts have been made to counteract its overactivation. Novel non-pharmacological, promising approaches targeting sympathetic nervous system are now available, such as renal denervation and baroceptor-activating therapy. This review is aimed at describing essential clinical aspects of resistant hypertension, physiopatological basis of autonomic modulation as a target for hypertension treatment, and the available clinical evidence about efficacy and safety of device-based therapies for resistant hypertension. Present limitations and future perspectives were also considered.

Keywords: Resistant hypertension, Sympathetic nervous system, renal denervation, baroceptor-activating therapy, cardiovascular risk factors, blood pressure, prognosis, autonomic modulation, clinical evidence, device-based therapies