What Is Treatment-Resistant Hypertension?

Treatment-resistant hypertension is blood pressure (BP) that stays above goal despite compliance with full doses of ≥3 antihypertensive medications of different classes; ideally, 1 of the 3 agents should be a diuretic1,2 and the treatment plan must include attention to lifestyle measures.1 Treatment-resistant hypertension could also include patients who achieve BP control but need ≥4 antihypertensive agents to do so.2

Using the body's own mechanisms to lower blood pressure

One of the body's primary methods for controlling blood pressure involves the sympathetic nervous system. This system includes the major organs that are responsible for regulating blood pressure: the brain, the heart, the kidney and the blood vessels themselves. One key player in long-term blood pressure regulation is the kidney. Renal nerves communicate information from the kidney to the brain, and vice versa.

In people with hypertension, the renal nerves are hyperactive, which raises blood pressure and contributes to heart, kidney and blood vessel damage. Selectively quieting hyperactive renal nerves causes a reduction in the kidneys’ production of hormones that raise blood pressure and may protect the heart, kidney and blood vessels from further damage.

Medtronic is investigating device-based approaches in renal denervation to control treatment-resistant hypertension.

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References

  1. Mancia G, De Backer G, Dominiczak A, et al. Eur Heart J. 2007;28:1462-1536.
  2. Calhoun DA, Jones D, Textor S, et al. Circulation. 2008;117(25):e510-e526.