Nonpharmacological therapies for uncontrolled hypertension

Uncontrolled or resistant hypertension, as defined as an office blood pressure ≥140/90 mmHg in individuals taking three different classes of antihypertensives (including a diuretic) at maximally tolerated doses or using ≥4 medications irrespective of blood pressure, may affect up to one fourth of all hypertensive patients. Therapeutic management of this condition remains a major challenge for clinicians. Failure of various pharmacological and structured programs has laid the groundwork for a labored search of alternative approaches to improve blood pressure control and patient-centered outcomes. This chapter will focus on several device-based interventions, currently available or under development, that are holding the promise to revolutionize the treatment of this condition, spanning from the now hackneyed renal denervation to more innovative approaches, like baroreflex stimulation, central arteriovenous coupler therapy, or central and peripheral nerve stimulation.