Novel methods to manage patients with difficult-to-control hypertension

Hypertension (HT) is the leading risk factor globally for cardiovascular disease and mortality. 10-20% of treated patients continue to have uncontrolled HT despite prescription of antihypertensive drugs. Such patients may need new approaches. Fadl El Mula and colleagues assessed efficacy and safety of two novel methods. One method was a mini-invasive: Renal sympathetic denervation (RDN) - interrupting part of the activity of the sympathetic nervous system by using radiofrequency ablation. As late as in 2011, RDN was described as a revolution in the treatment of HT. But the evidence is debated. In the well-designed randomized Oslo RDN study, RDN was found to be safe but less effective than using antihypertensive drugs. Interestingly many patients had their HT controlled after documented intake of their drugs. The other method was a non-invasive: Impedance cardiography (ICG) - hemodynamic profile of patient was measured and then used to individualize treatment-. In a randomized multi-center European trial, ICG was not more effective than conventional drug treatment. Fadl El Mula concluded that these two novel methods are not yet evidence-based medicine and not ready for routine clinical use