Non-pharmacological Interventions for Patients with Resistant Hypertension

Resistant hypertension is defined as the failure to reach a target blood pressure (BP) despite adherence to a regimen of the maximum tolerated doses of three antihypertensive medications, one of which is a diuretic. It is estimated that 20–30% of patients with hypertension have resistant hypertension. Age and obesity are strong risk factors and the incidence and prevalence of resistant hypertension may be rising as the population ages and the number of people who are overweight increases. The specific prognostic implications of resistant hypertension have not been analysed. Several studies point to the poor outcome associated with elevated BP; the outcome of resistant hypertension is likely impaired relative to hypertension that can be controlled with medication. Here, we give an overview of three novel, non-pharmacological therapies available for patients with resistant hypertension, including an implantable carotid stimulator (Rheos®), a paced breathing assistive device (RESPeRATE®) and a device designed to guide users through effective isometric handgrip exercise (Zona Plus™ and others). These unique approaches have so far demonstrated promising efficacy and safety and are likely to benefit patients who fail antihypertensive medical therapy. The exact process by which these devices lower BP remains elusive. However, studies in which this process is investigated have shed light on the possible mechanisms regulating long-term BP. Further investigation is necessary to establish the optimal role of these devices in relation to conventional antihypertensive pharmacotherapy. Some of these approaches may prove to be a relatively inexpensive and safe adjunctive, or even an alternative method to lowering BP.