Crosstalk opposing view: Which technique for controlling resistant hypertension? Carotid chemoreceptor denervation/modulation

摘要

The often asymptomatic condition of hypertension can soon become symptomatic with drug treatment. Over a third of patients report unwelcome medication side-effects and the majority would prefer to lower their blood pressure (BP) without medication (Benson & Britten, 2003). The chronicity of hypertension and the associated treatment side-effects lead to medication non-adherence. Recent data suggest that 25% of patients attending specialist hypertension clinics are non-adherent to medications, and 23% referred for renal denervation (RDN) were completely non-adherent to prescribed anti-hypertensive drugs (Tomaszewski 2014). Medication non-adherence is associated with increased risk of stroke and cardiovascular complications (Herttua et al 2013). Despite an armoury of poly-pharmacy there remains an unmet clinical need. Between 12 and 15% of patients with hypertension are drug resistant (BP > 140/90 mmHg despite >3 anti-hypertensive medications; NICE, 2011; Pimenta & Calhoun, 2012). These patients are at risk of significant morbidity and mortality, but there has been a dearth of new anti-hypertensive drugs licensed.