Guido Grassi, Gino Seravalle, Gianmaria Brambilla, Francesca Cesana, Cristina Giannattasio and Giuseppe Mancia Pages 63 - 68 ( 6 )
The two novel approaches recently introduced for the treatment of resistant hypertension, i.e. carotid baroreceptor stimulation and renal denervation, share a number of similarities but are also characterized by important differences. The similarities include the evidence that both interventions have as common pathophysiological background the state of sympathetic overdrive characterizing essential hypertension. In addition both procedures 1) are invasive, 2) exert in the short-term period clearcut blood pressure lowering effects and 3) still face a number of open questions, particularly related to the long-term blood pressure lowering effects, impact on end-organ damage and on cardiovascular events. The differences include the fact that two procedures act on distinct targets that trigger sympathetic activation and consequently blood pressure increase. In addition, only in the case of carotid baroreceptor stimulation the blood pressure effects can be easily assessed immediately following the implantation. Finally, the economic costs, metabolic effects and impact on vagal modulation of heart rate are different between the two interventions. This paper will provide a comparison of the background, effects and outcome of renal denervation and carotid baroreceptor stimulation, stressing whenever possible the clinical implications of the main features of the two interventions.
Resistant hypertension, renal denervation, carotid baroreceptor stimulation, symapthetic activity, end organ damage.
Clinica Medica, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20052 Monza (MI), Italy.