Recent advances in device therapies for resistant hypertension. Where do we stand?

Device-based treatment of patients with resistant hypertension has become an important adjunct to medical therapy, although its place in clinical practice has not yet been fully established. The present minireview discusses the current state of affairs of such treatment modalities. We searched the literature in PubMed and MEDLINE for all relevant papers.

Most information is available for renal denervation, baroreceptor activation therapy and endovascular baroreflex amplification. Of these, most data have been obtained in randomized trials of renal denervation. Other treatments that are still under investigation are carotid body ablation, cardiac neuromodulation, deep brain stimulation and vagal nerve stimulation. Although all these techniques have originally been developed for hypertension, they are used more and more in heart failure.

Currently, renal denervation is the only technique that may turn into a meaningful clinical treatment. It is effective, has a acceptable safety profile and is relatively easy to implement. Yet, more information is needed regarding long-term safety and effects on hard cardiovascular endpoints such as myocardial infarction and heart failure. All other forms of device-based treatment are not yet sufficiently developed.