Autonomic Neuromodulation through Devices for Hypertension

Hypertension continues to be a major contributor for total and cardiovascular morbidity and mortality. This is directly related to lack in blood pressure control despite multiple pharmacological options available. This may occur not only as a rare consequence of true-resistant hypertension (RHTN) but also due to lack of adherence, or mostly the consequence, of adverse drug reactions. In recent years, there has been a rapid expansion of device-based therapies proposed as novel nonpharmacological approaches to treating hypertension. In this review, we discuss novel devices-renal nerve denervation, baroreflex activation therapy (BAT), carotid body (CB) ablation, central iliac arteriovenous anastomosis, deep brain stimulation (DBS), median nerve stimulation, and vagal nerve stimulation (VNS). We highlight the mechanism of action of devices, the level of evidence available to date, and ongoing or upcoming trials. This review also suggests appropriate device selection for different hypertension phenotypes.