Deep brain stimulation for control of refractory hypertension

Deep brain stimulation (DBS) is an emerging treatment for patients with severe drug-resistant hypertension, particularly for those in whom other non-pharmacological treatments (e.g., renal denervation, baroreflex activation therapy) have failed. Growing numbers of case studies demonstrate long-term reductions in blood pressure with DBS of the ventrolateral periaqueductal gray. This is likely achieved via modulation of autonomic blood pressure control centres, reducing sympathetic outflow to the vasculature. We discuss recent advances, including whether the ventrolateral periaqueductal gray alone is a robust enough target, and whether DBS has the potential to reinstate beneficial physiological characteristics of blood pressure, such as diurnal variation.