Novel Neuromodulation Therapies for Heart Failure and Resistant Hypertension

Heart failure and resistant hypertension are major clinical challenges frequently associated with autonomic nervous system dysfunction and sustained sympathetic hyperactivity. In this context, neuromodulation therapies have emerged as innovative strategies aimed at restoring autonomic balance and improving cardiovascular outcomes. To critically analyze recent scientific evidence on new neuromodulation therapies applied to heart failure and resistant hypertension, emphasizing physiological mechanisms, clinical outcomes, and future perspectives for clinical practice. An integrative literature review was conducted in PubMed, JACC, SciELO, and the American College of Cardiology databases using descriptors related to vagal stimulation, baroreflex activation, and renal denervation. Studies published within the last ten years with a minimum follow-up of six months were included. The main strategies identified were vagus nerve stimulation, carotid baroreflex activation therapy, and renal denervation. The analyzed studies demonstrated improvements in autonomic modulation, reductions in sympathetic activity, functional gains, and, in selected trials, increases in left ventricular ejection fraction and blood pressure control. Neuromodulation therapies show relevant clinical potential as adjunctive treatments to conventional pharmacological therapy, particularly in refractory patients. However, methodological heterogeneity and limited long-term data highlight the need for robust clinical trials to support their routine clinical adoption.