title: Device-based Therapy for Hypertension.
abstract: Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension. In this review, we discuss seven novel devices-renal nerve denervation, baroreflex activation therapy, carotid body ablation, central iliac arteriovenous anastomosis, deep brain stimulation, median nerve stimulation, and vagal nerve stimulation. We highlight how the devices differ, the varying degrees of evidence available to date and upcoming trials. This review also considers the possible factors that may enable appropriate device selection for different hypertension phenotypes.
authors.affiliation: Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.|Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK.
authors.forename: Fu L
authors.initials: FL
authors.lastname: Ng
authors.affiliation: Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.|Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK.
authors.forename: Manish
authors.initials: M
authors.lastname: Saxena
authors.affiliation: Department of Internal Medicine, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.affiliation: Department of Cardiovascular Medicine, Hypertension and Heart Failure Unit, Health Innovation Lab (Hi-Lab) Clinique Pasteur, Toulouse, France.
authors.forename: Atul
authors.initials: A
authors.lastname: Pathak
authors.affiliation: Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK. m.d.lobo@qmul.ac.uk.|Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK. m.d.lobo@qmul.ac.uk.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Lobo
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical; D017704:Baroreflex / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002344:Carotid Body / Q000503:physiopathology / Q000601:surgery; D046690:Deep Brain Stimulation; D004599:Electric Stimulation Therapy; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D007083:Iliac Artery / Q000601:surgery; D007084:Iliac Vein / Q000601:surgery; D008475:Median Nerve / Q000503:physiopathology; D013562:Sympathectomy; D055536:Vagus Nerve Stimulation
chemical_list: D000959:Antihypertensive Agents
keywords: Arteriovenous anastomosis; Baroreflex activation; Carotid sinus stimulation; Coupler; Hypertension; Interventional devices; Renal denervation