Back to Life Treatment of Resistant Hypertension- An Update

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Resistant hypertension is characterized by severe and persistent high blood pressure that is not normalized even after administering two or more antihypertensive medications, of which one is a diuretic. Although resistant hypertension is commonly encountered in clinics, the prognosis is largely unclear. Mounting evidence indicate that resistant hypertension is a multifactorial pathology of diverse etiology. A wide variety of predisposed factors including age, ethnicity, obesity, obstructive sleep apnea, primary aldosteronism, chronic kidney disease, excessive sympathetic activation and baroreflex dysfunction may be implicated. Although a cocktail of three or four major classes of antihypertensive drugs are recommended for treatment, the benefits of pharmacological interventions is limited in many patients, so surgical denervation of the renal artery is widely practiced to improving patient outcome. Thus, surgical interventions include (i) renal sympathetic denervation, (ii) renal sympathetic innervation, and (iii) device-based carotid baroreceptor electric stimulation may be considered back-to-life options to treat resistant hypertension. Moreover, over the years, these surgical procedures have been refined and fine-tuned to optimize benefits, while minimizing adverse effects. Thus, the current surgical practice has been greatly improved from the time of inception. Therefore, this review will focus on the role of surgical interventions in the treatment and management of resistant hypertension. With the global escalation of hypertension in epidemic proportions and the huge socio-economic burden posed to patients, their families and healthcare systems, it is of utmost importance to improve treatment strategies for all forms of hypertension including resistant hypertension.