Place of baroreceptor activation therapy in the treatment of resistant hypertension

Table 1 Therapeutic strategies in patients with resistant hypertension

Recommendations	Class of recommendation1	Level of evidence2
In resistant hypertensive patients it is recommended that physicians check whether the drugs included in the existing multiple drug regimen have any BP lowering effect, and withdraw them if their effect is absent or minimal	I	C
Mineralocorticoid receptor antagonists, amiloride, and the alpha-1-blocker doxazosin should be considered, if no contraindications exist	IIa	B
In case of ineffectiveness of drug treatment invasive procedures such as renal denervation and baroreceptor stimulation may be considered	IIb	C
Until more evidence is available on the long-term efficacy and safety of renal denervation and baroreceptor stimulation, it is recommended that these procedures remain in the hands of experienced operators and diagnosis and follow-up restricted to hypertension centers	I	C
It is recommended that the invasive approaches are considered only for truly resistant hypertensive patients, with clinic values ≥ 160 mmHg SBP or ≥ 110 mmHg DBP and with BP elevation confirmed by ABPM	I	C

Class of recommendation¹: Class I: Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective; Class II: Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure; Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy; Class IIb: Usefulness/efficacy is less well established by evidence/opinion. Level of evidence²: Level of evidence B: Data derived from a single randomized clinical trial or large non-randomized studies; Level of evidence C: Consensus of opinion of the experts and/or small studies, retrospective studies, registries. ABPM: Ambulatory blood pressure monitoring; BP: Blood pressure; DBP: Diastolic blood pressure; SBP: Systolic blood pressure.