title: Device-Based Therapy for Drug-Resistant Hypertension: An Update.
abstract: Drug-resistant hypertension (RH) remains a significant and common cardiovascular risk despite the availability of multiple potent antihypertensive medications. Uncontrolled resistant hypertension contributes substantially to excessive cardiovascular and renal morbidity and mortality. Clinical and experimental evidence suggest that sympathetic nervous system over-activity is the main culprit for the development and maintenance of drug-resistant hypertension. Both medical and interventional strategies, targeting the sympathetic over-activation, have been designed in patients with hypertension over the past few decades. Minimally invasive, catheter-based, renal sympathetic denervation (RDN) and carotid baroreceptor activation therapy (BAT) have been extensively evaluated in patients with RH in clinical trials. Current trial outcomes, though at times impressive, have been mostly uncontrolled trials in need of validation. Device-based therapy for drug-resistant hypertension has the potential to provide alternative treatment options to certain groups of patients who are refractory or intolerant to current antihypertensive medications. However, more research is needed to prove its efficacy in both animal models and in humans. In this article, we will review the evidence from recent renal denervation, carotid baroreceptor stimulation therapy, and newly emerged central arteriovenous anastomosis trials to pinpoint the weak links, and speculate on potential alternative approaches.
authors.affiliation: Washington Veterans Affairs Medical Center, 50 Irving Street, N.W., Washington, DC, 20422, USA.|Georgetown University Hospital, Washington, DC, USA.|George Washington University Hospital, Washington, DC, USA.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Georgetown University Hospital, Washington, DC, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Nader
authors.affiliation: Georgetown University Hospital, Washington, DC, USA.
authors.forename: Kousalya
authors.initials: K
authors.lastname: Arunagiri
authors.affiliation: Washington Veterans Affairs Medical Center, 50 Irving Street, N.W., Washington, DC, 20422, USA. Vasilios.Papademetriou@va.gov.|Georgetown University Hospital, Washington, DC, USA. Vasilios.Papademetriou@va.gov.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
mesh_terms: D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000628:therapy; D002344:Carotid Body / Q000503:physiopathology*; D004195:Disease Models, Animal; D004351:Drug Resistance; D004599:Electric Stimulation Therapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D011311:Pressoreceptors / Q000503:physiopathology; D012307:Risk Factors; D013562:Sympathectomy
chemical_list: D000959:Antihypertensive Agents
keywords: Device-based interventional therapy; Drug-resistant hypertension; Sympathetic nervous system over-activity