[Invasive treatment of hypertension : Update 2016]

Area of Science:

• Cardiology
• Nephrology
• Medical Devices

Background:

• Therapy-resistant hypertension poses a significant clinical challenge.
• Invasive methods like renal denervation and baroreceptor activator therapy have been explored for treatment.
• Renal denervation initially showed promise due to its procedural simplicity.

Purpose of the Study:

• To evaluate the efficacy of invasive treatments for therapy-resistant hypertension.
• To compare renal denervation and baroreceptor activator therapy against established treatments.
• To assess the current status and future directions of invasive hypertension therapies.

Main Methods:

• Review of randomized, blinded studies comparing renal denervation to sham procedures.
• Analysis of studies investigating intensified drug therapy, including spironolactone.
• Evaluation of baroreceptor activator therapy and novel arteriovenous shunt interventions.

Main Results:

• Three major randomized trials found no significant benefit of renal denervation over sham procedures.
• Intensified pharmacotherapy, especially with spironolactone, demonstrated comparable efficacy.
• Baroreceptor activator therapy shows potential but requires device optimization; arteriovenous shunts lack long-term safety data.

Conclusions:

• Current evidence does not support renal denervation as a superior treatment for resistant hypertension.
• Invasive procedures for resistant hypertension should be conducted within research protocols or registries.
• Further research is needed to optimize invasive therapies and confirm long-term safety and efficacy.