Recent Developments and Controversies in the Treatment of Resistant Hypertension

Abstract

Resistant hypertension is defined as elevated blood pressure despite the appropriate use of 3 or more antihypertensive drugs, including a diuretic, and constitutes a frequent and important clinical problem with significant disease morbidity and mortality. Several sources of evidence point to the sympathetic nervous system as a major protagonist in this disease entity. The catheter-based, radiofrequency ablation of renal sympathetic nerves (renal denervation) to treat resistant hypertension has sparked great enthusiasm. However, failure of this interventional approach in the randomized, sham-controlled Symplicity HTN-3 trial to reach its efficacy endpoint of attaining a significant blood pressure reduction has called this intervention into substantial question and fueled an ongoing scientific debate. Electrical stimulation of the carotid baroreceptors (baroreflex activation therapy) represents another technique to modulate sympathetic activity currently being studied in several clinical trials. This review summarizes and comments the current literature focusing on the invasive treatment of resistant hypertension.

Hypertension and Diabetic Nephropathy

“…The focus then moves to treatment of hypertension in diabetes and reveals a discussion of renin angiotensin aldosterone blockade in general [11] and the role of dual RAS blockade in detail [12]. Besides medical treatment as recently underlined by the PATHWAY-2study [13], there might be alternative options such as yoga [14] or more invasive procedures such as renal denervation [15], which are also discussed extensively in this issue. However one should not underestimate the coincidence of other diseases leading to hypertension, such as primary aldosteronism [16] and renal artery stenosis [17], also reviewed in detail.…”

Results of the trycort: Cohort study of add-on antihypertensives for treatment of resistant hypertension

“…[9] Although there are also invasive methods of treating resistant hypertension, that is, electrical stimulation of the carotid baroreceptors and baroreflex activation therapy, their efficacy in clinical trials needs to be confirmed with phase-3 studies. [10][11][12] The catheter-based radiofrequency ablation of renal sympathetic nerves, that is, renal denervation, has emerged as an effective therapeutic option in addition to the nonpharmacological treatment and antihypertensive drugs. [13] When various add-on drugs for resistant hypertension were compared among themselves in clinical trials and meta-analyses, spironolactone showed the best efficacy, but yet the published data are limited, [14] and additional studies are needed to confirm already published studies.…”

Hypertension and Diabetic Nephropathy

“…The focus then moves to treatment of hypertension in diabetes and reveals a discussion of renin angiotensin aldosterone blockade in general [8] and the role of dual RAS blockade in detail [9]. Besides medical treatment as recently underlined by the PATHWAY-2-study [15], there might be alternative options such as yoga [16] or more invasive procedures such as renal denervation [17], which are also discussed extensively in this issue. However one should not underestimate the coincidence of other diseases leading to hypertension, such as primary aldosteronism [10] and renal artery stenosis [11], also reviewed in detail in the current issue of the journal, which you are holding in your hands.…”