Innovative Treatment Options in Resistant Arterial Hypertension

Two new treatment options of non-drug therapy have been available for several years. Since 2003, electrical stimulation of the carotid baroreceptors has been performed by operative implantation of electrodes and a programmable pulse generator to reduce blood pressure. Since 2007, minimally invasive renal denervation by catheter is possible for ablation of the afferent and efferent renal sympathetic nervous fibers surrounding the renal artery. Both therapies reduce systolic blood pressure in 70-90 % of patients by at least 10 mmHg. 12 months after carotis pacemaker implantation the average blood pressure reduction is 30-35/1520 mmHg. Comparable data have been published for renal denervation but there is a tendency that the reduction is slightly less pronounced. Patients with a carotis stenosis > 50 % or large carotis plaques are not suitable for baroreceptor stimulation. Renal denervation is contraindicated in patients with renal artery stenosis or a history of renal artery stenting. Additionally, patients with an eGFR < 45 ml/min are presently excluded from this intervention.