title: Interventional procedures and future drug therapy for hypertension.
abstract: Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious. For those patients who either do not tolerate or wish to take medication for hypertension or in whom BP control is not attained despite multiple antihypertensives, a novel class of interventional procedures to manage hypertension has emerged. While most of these target various aspects of the sympathetic nervous system regulation of BP, an additional procedure is now available, which addresses mechanical aspects of the circulation. Most of these new devices are supported by early and encouraging evidence for both safety and efficacy, although it is clear that more rigorous randomized controlled trial data will be essential before any of the technologies can be adopted as a standard of care.
authors.affiliation: Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.|William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Lobo
authors.affiliation: The Ohio State University, Columbus, OH, USA.|ROX Medical, San Clemente, CA, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
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
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000379:methods / Q000639:trends; D017704:Baroreflex / Q000502:physiology; D017115:Catheter Ablation / Q000639:trends; D002986:Clinical Trials as Topic; D046690:Deep Brain Stimulation / Q000379:methods / Q000639:trends; D004546:Elapid Venoms / Q000819:agonists; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000235:genetics / Q000276:immunology / Q000628:therapy*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D020098:Natriuretic Peptide, C-Type / Q000819:agonists; D015260:Neprilysin / Q000037:antagonists & inhibitors; D009416:Nerve Regeneration / Q000502:physiology; D009638:Norepinephrine / Q000037:antagonists & inhibitors; D010455:Peptides / Q000627:therapeutic use; D012084:Renin-Angiotensin System / Q000502:physiology; D013562:Sympathectomy / Q000379:methods / Q000639:trends; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods / Q000639:trends; D014660:Vasoactive Intestinal Peptide / Q000627:therapeutic use
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; C542600:CD-NP natriuretic peptide; D004546:Elapid Venoms; D000451:Mineralocorticoid Receptor Antagonists; D010455:Peptides; C029311:serum sodium transport inhibitor; D020098:Natriuretic Peptide, C-Type; D014660:Vasoactive Intestinal Peptide; D015260:Neprilysin; D009638:Norepinephrine
keywords: Arteriovenous anastomosis; Baroreflex activation; Drug therapy; Hypertension; Renal denervation; Sympathetic nervous system