Resistant Hypertension and the Role of Renal Denervation - Research Paper Example

Hypertension is a common problem worldwide and is one of the major causes of mortality and morbidity. It is associated with several complications like cardiovascular disease, stroke, retinopathy, and renal dysfunction. Elevated blood pressure which has been uncontrolled for a prolonged duration of time can lead to many changes in the structure, blood vessels and the conducting system of the heart. These changes can lead to the development of various conditions of the heart such as coronary artery disease, left ventricular hypertrophy, cardiac arrhythmias, and congestive heart failure.

The pathophysiology of hypertensive heart disease is a complex interplay of various structural, neuroendocrine, hemodynamic, molecular and cellular factors (Riaz, 2007). These factors not only have a role in the development of hypertensive heart disease, they also are modulated by elevated blood pressure (Riaz, 2007). Persistent elevation of BP has adverse effects on the cardiac function and structure due to increased afterload and also due to vascular and neurohormonal changes (Riaz, 2007). Several medications and strategies have been developed to decrease blood pressure in patients with hypertension and despite these measures; hypertension continues to be a challenge for some patients.

Hypertension not responding to routine medical treatment has been categorized as resistant hypertension. Resistant hypertension can be defined as that blood pressure that is above the estimated goal for the age and gender of the patient, despite concurrent use of at least 3 antihypertensive drugs of different mechanism of action, i.e., different classes of antihypertensive agents. Ideally, one of the antihypertensive agents should be a diuretic and optimal doses of the agents must be prescribed.

Such a stringent definition is necessary to identify patients whose hypertension can be controlled by revising pharmacological treatment and also in whom identifiable causes of hypertension exist which when treated can reverse the need for high doses of antihypertensives.