Recent advances in understanding and managing resistant/refractory hypertension

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Resistant hypertension management poses significant clinical challenges.
• Recent research explores novel pharmacological and non-pharmacological strategies.
• Spironolactone has emerged as a promising therapeutic option.

Purpose of the Study:

• To review current pharmacological and device-based treatment options for resistant hypertension.
• To evaluate the efficacy of spironolactone compared to other agents.
• To assess the status of interventional approaches like renal sympathetic denervation and carotid baroreceptor activation therapy.

Main Methods:

• Analysis of clinical trial data, including the PATHWAY-2 trial.
• Review of European guidelines for hypertension management.
• Evaluation of recent studies on device-based therapies.

Main Results:

• Spironolactone demonstrated significant benefits as a fourth-line treatment for resistant hypertension, outperforming doxazosin and bisoprolol.
• Spironolactone may be superior to central-acting drugs.
• Renal sympathetic denervation and iliac anastomosis showed initial promise but faced setbacks; carotid baroreceptor activation therapy requires further validation.

Conclusions:

• Spironolactone is a recommended fourth-line option for resistant hypertension.
• Device-based therapies are currently limited to clinical trials due to ongoing safety and efficacy evaluations.