Resistant Blood Pressure: New Frontiers in Interventional Hypertension Therapy

Hypertension remains a leading global health challenge, affecting over 1.3 billion individuals worldwide and contributing significantly to cardiovascular morbidity and mortality. In recent years, interventional device-based therapies have emerged as promising adjuncts by targeting sympathetic overactivity and autonomic dysregulation, key mechanisms in the pathogenesis of hypertension. Currently, the use of these interventional therapies is primarily reserved for patients with resistant hypertension (RH) who remain uncontrolled despite optimal medical therapy. This review provides an overview of the evolving landscape of interventional approaches, including renal denervation (RDN), baroreceptor activation therapy (BAT), carotid body modulation, hepatic denervation, and cardiac neuromodulation. Among these, RDN has the most robust clinical trial evidence, while other neuromodulatory strategies are being evaluated in early-phase studies. Additionally, this review underscores the importance of systematically identifying and managing secondary causes of hypertension, such as primary aldosteronism, renovascular disease, and obstructive sleep apnea, before considering procedural interventions. As the field advances, these therapies may assume a more prominent role in precision-based hypertension management.