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When blood pressure refuses to go down

Five to 15 percent of all patients with hypertension fail to respond to drug treatment. However, a range of treatment options are now available in these cases. Alongside the established measures stand new and promising interventions such as renal sympathetic denervation. Felix Mahfoud, Frank Himmel and their co-authors present the current treatment strategies for resistant arterial hypertension in the latest issue of Deutsches rzteblatt International (Dtsch Arztebl Int 2011; 108(43): 725).

A multimodal interdisciplinary strategy is necessary for the successful treatment of resistant arterial hypertension. Drug treatment must be tailored to the individual patient, and reversible or secondary causes of hypertension must be systematically sought and treated. The important non-pharmacological conservative treatment measures include optimization of weight, a low-salt diet, physical exercise, and abstinence from alcohol.

Minimally invasive renal denervation and baroreceptor stimulation are two alternative treatment options for selected patients with resistant arterial hypertension. Renal sympathetic denervation is an interventional procedure with a low rate of complications that can bring about a significant and enduring reduction in blood pressure. For conclusive evaluation of the long-term effects and safety of this new approach, patients have to be enrolled in clinical registries and monitored at regular intervals following treatment. In Germany, the German Renal Denervation (GREAT) Registry has been set up for this purpose.

Arterial hypertension is among the most common chronic diseases in the western industrialized nations and is a major risk factor for cardiovascular morbidity and mortality.

Contact: Dr. med. Felix Mahfoud
Deutsches Aerzteblatt International

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