Device-based Therapies for Hypertension

Hypertension is a major public health issue and due to poor blood pressure (BP) control rates, worldwide, alternative nonpharmacological therapies are being sought to help improve blood pressure control. There are multiple catheter-based renal denervation (RDN) devices that are available and being studied in various hypertensive populations. The procedure has been shown to be safe, but the efficacy has been variable and enthusiasm for the procedure has been tempered particularly after the negative results from the largest RDN sham-controlled study – SYMPLICITY HTN-3 study. New studies are underway in investigating this technology in patients with less severe hypertension using a dual approach of a group off medication and a group on one to three standard antihypertensive medications. The rationale behind this study design is that in untreated hypertension, this approach will isolate the blood pressure lowering effect of the RDN procedure itself, and in the group assigned to standard antihypertensives, this study design will evaluate the effect of RDN in the presence of a standardized medication regimen. Other innovative noninvasive methods of RDN including a noninvasive ultrasound technology are also being investigated. Baroreceptor inhibition is also continuing to be studied by investigating a newer more patient-friendly device using a unilateral carotid baroreceptor stimulator. Other newer innovative technologies and devices are also discussed including ethanol-based sympathicolysis of the renal nerves and use of an arteriovenous fistula (AVF) device to lower blood pressure. All these methodologies should be considered experimental and cannot be recommended currently for clinical care.