Purpose of review: Hypertension (HTN) is a ubiquitous condition and cause for significant morbidity and mortality. Over 400 000 deaths in the United States are related to HTN every year, more than all the Americans who died through all of World War II. As many as half the patients with HTN in the United States have resistant HTN, a blood pressure greater than 140/90 mmHg despite three medications including a diuretic. It appears that the prevalence of HTN and resistant HTN is increasing over time. There is a dire need for newer therapies that may reduce or eliminate the need for multiple pharmacologic agents, thus helping with compliance and reducing the possibility of their adverse events.
Recent findings: The current review summarizes the techniques and results reported in recent studies utilizing renal denervation technologies from the original Symplicity Trials to newer multipolar electrodes being used for optimal denervation. We also report the early experience with noninvasive renal denervation. Endovascular carotid body stimulation is also being investigated for resistant HTN. Renovascular HTN remains an underlying cause for resistant HTN, and revascularization may prove to be an effective treatment for many of these patients.
Summary: A multipronged approach utilizing lifestyle modification, pharmacologic therapy and tailored endovascular treatments may be the algorithm to treat the growing cohort of resistant HTN. However, most of the endovascular treatments remain to be validated, and renal revascularization for renovascular HTN has been set back by recent studies that did not appear to target the real renovascular cohort.