Innovative device-based treatments for hypertension

The World Health Organization (WHO) estimates that the number of people living with hypertension (blood pressure (BP) of ≥ 140 mmHg systolic or ≥ 90 mmHg diastolic or on medication) doubled between 1990 and 2019, from 650 million to 1.28 billion. Elevated BP is associated with increased risks of stroke, coronary artery disease (CAD), heart failure (HF), and chronic kidney disease (CKD). Resistant hypertension (RH) is defined as office BP ≥ 140/90 mmHg despite treatment with three classes of antihypertensive agents (including a diuretic) at maximally tolerated doses, or the need for four or more agents regardless of BP level. Device-based antihypertensive therapies primarily target autonomic nervous system through techniques, such as renal denervation, carotid baroreceptor activation, and carotid body ablation. This review outlines the pathophysiological basis of selected interventions, critically evaluates existing clinical evidence, and highlights future directions for their development and integration into clinical practice.