Copyright ©The Author(s) 2016.
World J Hypertens. Feb 23, 2016; 6(1): 36-40
Published online Feb 23, 2016. doi: 10.5494/wjh.v6.i1.36
Table 1 Therapeutic strategies in patients with resistant hypertension
RecommendationsClass of recommendation1Level 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 minimalIC
Mineralocorticoid receptor antagonists, amiloride, and the alpha-1-blocker doxazosin should be considered, if no contraindications existIIaB
In case of ineffectiveness of drug treatment invasive procedures such as renal denervation and baroreceptor stimulation may be consideredIIbC
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 centersIC
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 ABPMIC
Table 2 Similarities and differences between renal denervation and baroreceptor activation therapy
FeaturesRenal denervationBAT
BP short-term
BP long-term??
Evidence of successDelayImmediate
Heart rate effect↓↓
Metabolic effectYes?
Need for follow-upYesYes