title: [New invasive therapies for management of resistant hypertension].
abstract: The failure of pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments. New catheter systems using radiofrequency or ultrasound energy have been developed, allowing a percutaneous endovascular approach to renal denervation for patients with resistant hypertension. To date, this technique has been evaluated only in a few open-label trials including small numbers and the available evidence suggests a favorable blood pressure-lowering effect in the short-term and a low incidence of immediate complications. All studies published to date have several limitations due to their open-label design. Carotid baroreceptor stimulation requires surgical implantation of electrodes connected to a stimulator. Preliminary results show a positive effect on blood pressure with a complication rate similar to the implantation of a pacemaker. In this context, there are arguments against an uncontrolled use of these procedures in routine practice: an unknown benefit/risk ratio, a variable blood pressure response, absence of cost-effectiveness evaluation. The indications of these procedures should follow the 2013 European Society of Hypertension guidelines. A strict follow-up of patients remains necessary at best by including them in clinical trials or international registries.
authors.affiliation: Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Hypertension Artérielle, 20 rue Leblanc, 75015 Paris, France - Université Paris-Descartes, Faculté de Médecine, 15 rue de l'École de Médecine, 75006 Paris, France - INSERM, CIC HEGP 1418, 20 rue Leblanc, 75015 Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Azizi
mesh_terms: D004558:Electric Stimulation; D004599:Electric Stimulation Therapy / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007668:Kidney / Q000294:innervation / Q000601:surgery; D011311:Pressoreceptors / Q000502:physiology; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods; D017211:Treatment Failure