title: Interventional management in hypertension: where do we stand?
abstract: OBJECTIVE
  Device-based interventions to lower drug-resistant hypertension have made the management of this disorder more complicated. In this review, we will focus on developments in this approach to blood pressure care which have appeared over the last year in a published or abstract form.
  
  
  RESULTS
  Much of the recent literature in this area is characterized by very large office systolic blood pressure reductions, on the order of 25 mmHg at 6 months after intervention. However, the largest and the most rigorously conducted trial of renal denervation failed to meet its efficacy endpoint. We will review some speculations on why that may have occurred.
  
  
  CONCLUSIONS
  There is little guidance for the management of drug-resistant hypertension in existing guidelines due largely to an absence of clinical trials with hard cardiovascular outcomes; thus, most of the literature relies on short-term (generally less than 1 year) studies that are oriented toward efficacy (i.e., blood pressure reduction per se). With the failure of the Symplicity HTN3 trial to meet its efficacy endpoint, the entire field of renal denervation is under careful scrutiny. From this reviewer's perspective, this finding seems to be more of a speed-bump than a 'road closed' sign for renal denervation, a prompt to reconsider the adequacy of denervation techniques and an encouragement to continue the search for robust predictors of clinical response.
authors: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia, USA.
authors: Raymond R
authors: RR
authors: Townsend
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D017763:Autonomic Denervation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D002986:Clinical Trials as Topic / Q000379:methods; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D012107:Research Design; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents