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Updated: Jul 16, 2025
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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
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Management of Resistant Hypertension
Lucas Lauder1, Felix Mahfoud1, Michael Böhm1
1Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany; email: Lucas.Lauder@uks.eu, Felix.Mahfoud@uks.eu, Michael.Boehm@uks.eu.
Annual Review of Medicine
|September 22, 2023
Summary
Resistant hypertension (RH) management involves lifestyle changes and medications. Emerging interventional therapies like renal denervation offer new options for this severe condition.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Resistant hypertension (RH) is a severe condition linked to elevated cardiovascular risks.
- Despite affecting less than 10% of patients, the prevalence of RH is substantial and growing.
- Proper RH management requires ruling out secondary causes and pseudoresistance, such as non-adherence and white-coat hypertension.
Purpose of the Study:
- To review the rationale and recent clinical evidence for managing resistant hypertension.
- To propose an updated management algorithm for resistant hypertension based on current data.
- To highlight emerging interventional therapies, including renal denervation, as adjunct treatments.
Main Methods:
- Literature review of clinical evidence and therapeutic strategies for resistant hypertension.
- Analysis of pharmacological and lifestyle modification approaches.
- Evaluation of interventional techniques, specifically catheter-based renal denervation.
Main Results:
- Current RH treatment includes lifestyle modifications (diet, weight loss, exercise, alcohol limitation) and pharmacotherapy (diuretics, MRAs, beta-blockers, ARNI).
- Interventional approaches, notably renal denervation, have gained traction as adjunctive therapies over the past 15 years.
- The review synthesizes evidence to support an updated clinical algorithm.
Conclusions:
- Resistant hypertension necessitates a comprehensive management strategy combining lifestyle, pharmacotherapy, and potentially interventional procedures.
- Renal denervation represents a promising interventional option for select RH patients.
- An updated evidence-based algorithm can guide clinicians in optimizing RH treatment and reducing cardiovascular risk.
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