title: New approaches in the treatment of hypertension.
abstract: Hypertension is the most common modifiable risk factor for cardiovascular disease and death, and lowering blood pressure with antihypertensive drugs reduces target organ damage and prevents cardiovascular disease outcomes. Despite a plethora of available treatment options, a substantial portion of the hypertensive population has uncontrolled blood pressure. The unmet need of controlling blood pressure in this population may be addressed, in part, by developing new drugs and devices/procedures to treat hypertension and its comorbidities. In this Compendium Review, we discuss new drugs and interventional treatments that are undergoing preclinical or clinical testing for hypertension treatment. New drug classes, eg, inhibitors of vasopeptidases, aldosterone synthase and soluble epoxide hydrolase, agonists of natriuretic peptide A and vasoactive intestinal peptide receptor 2, and a novel mineralocorticoid receptor antagonist are in phase II/III of development, while inhibitors of aminopeptidase A, dopamine β-hydroxylase, and the intestinal Na(+)/H(+) exchanger 3, agonists of components of the angiotensin-converting enzyme 2/angiotensin(1-7)/Mas receptor axis and vaccines directed toward angiotensin II and its type 1 receptor are in phase I or preclinical development. The two main interventional approaches, transcatheter renal denervation and baroreflex activation therapy, are used in clinical practice for severe treatment resistant hypertension in some countries. Renal denervation is also being evaluated for treatment of various comorbidities, eg, chronic heart failure, cardiac arrhythmias and chronic renal failure. Novel interventional approaches in early development include carotid body ablation and arteriovenous fistula placement. Importantly, none of these novel drug or device treatments has been shown to prevent cardiovascular disease outcomes or death in hypertensive patients.
authors.affiliation: From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama (S.O.); and Department of Nephrology and Hypertension, University Hospital of the University Erlangen-Nürnberg, Germany (R.E.S.). soparil@uab.edu.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama (S.O.); and Department of Nephrology and Hypertension, University Hospital of the University Erlangen-Nürnberg, Germany (R.E.S.).
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000818:Animals; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001166:Arteriovenous Shunt, Surgical; D017704:Baroreflex / Q000502:physiology; D002344:Carotid Body / Q000601:surgery; D002986:Clinical Trials as Topic; D015897:Comorbidity; D019299:Decompression, Surgical; D015195:Drug Design; D015507:Drugs, Investigational / Q000494:pharmacology / Q000627:therapeutic use*; D004599:Electric Stimulation Therapy; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000201:enzymology / Q000473:pathology / Q000628:therapy*; D007473:Ion Channels / Q000187:drug effects; D007668:Kidney / Q000294:innervation; D007684:Kidney Tubules / Q000187:drug effects / Q000503:physiopathology; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D023421:Models, Animal; D058990:Molecular Targeted Therapy; D015337:Multicenter Studies as Topic; D018384:Oxidative Stress / Q000187:drug effects; D011225:Pre-Eclampsia / Q000188:drug therapy / Q000517:prevention & control; D011247:Pregnancy; D011311:Pressoreceptors / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D011956:Receptors, Cell Surface / Q000037:antagonists & inhibitors; D012077:Renal Artery / Q000601:surgery; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D015607:Stents; D013562:Sympathectomy / Q000379:methods; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D035703:Therapies, Investigational
chemical_list: D000959:Antihypertensive Agents; D015507:Drugs, Investigational; D004791:Enzyme Inhibitors; D007473:Ion Channels; D000451:Mineralocorticoid Receptor Antagonists; D011956:Receptors, Cell Surface
keywords: blood pressure; drug; hypertension; interventional; treatment