Device-based therapies for arterial hypertension

Arterial hypertension is the most prevalent modifiable risk factor associated with cardiovascular morbidity and mortality. Although antihypertensive drugs are widely available, in many patients blood pressure control to guideline-recommended target values is not achieved. Several device-based approa...

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Bibliographic Details
Published in:Nature reviews cardiology Vol. 17; no. 10; pp. 614 - 628
Main Authors: Lauder, Lucas, Azizi, Michel, Kirtane, Ajay J, Böhm, Michael, Mahfoud, Felix
Format: Journal Article
Language:English
Published: England Nature Publishing Group 01.10.2020
Subjects:
Antihypertensives
Baroreflex - physiology
Blood pressure
Blood Pressure - physiology
Carotid Body - physiology
Drug resistance
Electric Stimulation Therapy - methods
Electrodes, Implanted
Humans
Hypertension
Hypertension - physiopathology
Hypertension - therapy
Kidney - blood supply
Kidney - innervation
Pacemaker, Artificial
Radiofrequency Ablation
Sympathectomy - instrumentation
Sympathectomy - methods
Ultrasonic Therapy
ISSN:1759-5002, 1759-5010, 1759-5010
Online Access:Get full text
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Summary:Arterial hypertension is the most prevalent modifiable risk factor associated with cardiovascular morbidity and mortality. Although antihypertensive drugs are widely available, in many patients blood pressure control to guideline-recommended target values is not achieved. Several device-based approaches have been introduced to lower blood pressure; most of these strategies aim to modulate autonomic nervous system activity. Clinical trials have moved from including patients with resistant hypertension receiving intensive pharmacological treatment to including patients with mild-to-moderate hypertension in the presence or absence of antihypertensive medications. Renal sympathetic denervation is the most extensively investigated device-based therapy for hypertension, and randomized, sham-controlled trials have provided proof-of-principle data for its blood pressure-lowering efficacy. Unilateral electrical baroreflex activation, endovascular baroreflex amplification and pacemaker-mediated cardiac neuromodulation therapy have yielded promising results in observational trials, which need to be confirmed in larger, adequately powered, sham-controlled trials. Until further evidence becomes available, device-based therapy for hypertension should not be considered for routine treatment. However, when considering a device-based treatment for hypertension, the underlying pathophysiology in each patient has to be taken into consideration, and the procedural risks weighed against the cardiovascular risk attributable to the elevated blood pressure. This Review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for hypertension.
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ISSN:1759-5002
1759-5010
1759-5010
DOI:10.1038/s41569-020-0364-1