Experimental therapies
New experimental techniques are being evaluated to reduce BP in RH. A randomized trial of 106 patients on five antihypertensive medications, including a diuretic, underwent catheter-based radiofrequency ablation of the renal sympathetic nerves and was conducted for six months. The technique decreased BP from 178/97 mm Hg to 143/85 mm Hg.67-69
In another cohort study, BP was reduced by 23/11 mm Hg at 12-months and 32/14 mm Hg at 24-months using the same technique.69 Complications related to radiofrequency ablation are rare and include femoral artery pseudoaneurysm.
Another experimental therapy for RH is the use of electrical stimulation of the carotid sinus baroreflex system. In a study involving 45 patients with a mean BP of 179/105 mm Hg (maintaining on five medications), there was a mean reduction by 21/12 mm Hg at three months after device implantation, and 32/22 mm Hg after two years.70
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Summary
RH is more prevalent today with increased incidence of obesity, and higher caloric and salt intake in the general populus. Effective management should be based on pathophysiologic principles and outcome data. This requires careful examination and the exclusion of factors associated with pseudo resistance. The modification of factors related to true resistance is needed to achieve better BP goals.
An aggressive treatment should be designed to compensate for all mechanismsof BP elevation in a given patient. The proper combination of antihypertensive medications should be instituted, and, if this fails, the patient should be referred to an HT specialist. Hopefully, experimental therapies will achieve more effective BP control in difficult cases of RH going forward.
