What is the prevalence of resistant hypertension in the United States? Curr Opin Cardiol. 2012;27:386-391. [PMID: 22596184 DOI: 10.1097/hco.0b013e328353ad6e]

Identifying patients with resistant hypertension and options for clinical management

In addition to the increasing prevalence of hypertension, the number of patients with treatment-resistant hypertension is also rising. It is important to identify these patients in order to improve the treatment outcomes and to screen for potential secondary causes. Clinical characteristics of patients with resistant hypertension include advanced age, male gender, obesity, high salt intake and alcohol consumption. Those with high baseline blood pressure, diabetes, chronic kidney disease or obstructive sleep apnea are also prone to developing resistant hypertension. Physicians should initiate close monitoring and aggressive treatment for those patients, as resistant hypertension is associated with a higher risk of cardiovascular morbidities, regardless of the control of blood pressure. However, treatment of resistant hypertension is currently a great challenge in clinical practice as all of these patients are already taking multiple antihypertensive medications, including the first-line treatments advocated in guidelines. In patients who have been presented multiple drugs, the room for further titration is often limited. Spironolactone has been demonstrated to be effective as an add-on therapy for patients with resistant hypertension. In addition to drug treatment, baroreceptor stimulation therapy and renal sympathetic denervation are promising new approaches in this group of patients. Further studies on the pathogenesis and the treatment of resistant hypertension would help to improve the outcome of this patient subgroup.

Effectiveness of renal denervation therapy for resistant hypertension: a systematic review and meta-analysis

OBJECTIVES

This study sought to determine the current effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension.

BACKGROUND

RDN is a novel approach that has been evaluated in multiple small studies.

METHODS

We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models.

RESULTS

We identified 2 randomized controlled trials, 1 observational study with a control group, and 9 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic blood pressure (BP) at 6 months of -28.9 mm Hg (95% confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11.0 mm Hg (95% CI: -16.4 to -5.7 mm Hg), respectively, compared with medically treated patients (for both, p < 0.0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic BP at 6 months of -25.0 mm Hg (95% CI: -29.9 to -20.1 mm Hg) and -10.0 mm Hg (95% CI: -12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, p < 0.00001). There was no difference in the effect of RDN according to the 5 catheters employed. Reported procedural complications included 1 renal artery dissection and 4 femoral pseudoaneurysms.

CONCLUSIONS

RDN resulted in a substantial reduction in mean BP at 6 months in patients with resistant hypertension. The decrease in BP was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.