This protocol addresses patients whose blood pressure remains uncontrolled after a fifth-line antihypertensive regimen, and for whom a further escalation step is clinically warranted.
The preceding step involved adding one of the following agents to existing therapy: amiloride, a beta blocker, an alpha-blocker, a central sympatholytic drug, aprocitentan, or a direct vasodilator (hydralazine or minoxidil). The goal of that step — average SBP <130 mm Hg and DBP <80 mm Hg — was not achieved, making the current protocol the next appropriate step.
In carefully selected patients who have not achieved blood pressure targets despite optimal antihypertensive drug therapy — or who cannot tolerate additional medication — an interventional procedure known as renal denervation (RDN) may be considered as an adjunct to ongoing medications and lifestyle modification.
DOI: 10.1161/CIR.0000000000001356
In carefully selected patients with systolic and diastolic hypertension (office SBP 140–180 mm Hg and DBP ≥90 mm Hg) and eGFR ≥40 mL/min/1.73 m² who have resistant hypertension despite optimal treatment, or intolerable side effects to additional antihypertensive drug therapy, renal denervation (RDN) may be reasonable as an adjunct treatment to BP medications and lifestyle modification to reduce BP.