Hypertension is universally considered the most detrimental among cardiovascular risk factors. Despite the overwhelming evidence
of benefits deriving from lowering blood pressure, its control among the hypertensive population is still unsatisfactory. Resistant
hypertension has a non negligible prevalence among hypertensive patients, and it is associated with a worse cardiovascular prognosis.
There is need of new therapeutic approaches for reducing cardiovascular risk in this population.
Sympathetic nervous system is known to play a major role in development and maintenance of essential hypertension, thus in the past
decades several efforts have been made to counteract its overactivation. Novel non-pharmacological, promising approaches targeting
sympathetic nervous system are now available, such as renal denervation and baroceptor-activating therapy. This review is aimed at describing
essential clinical aspects of resistant hypertension, physiopatological basis of autonomic modulation as a target for hypertension
treatment, and the available clinical evidence about efficacy and safety of device-based therapies for resistant hypertension. Present limitations
and future perspectives were also considered.
Keywords: Resistant hypertension, Sympathetic nervous system, renal denervation, baroceptor-activating therapy, cardiovascular risk factors, blood pressure, prognosis, autonomic modulation, clinical evidence, device-based therapies
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