Overview of resistant hypertension: A glimpse of the cardiologist’s current standpoint

Table 1 Summary of therapeutic approaches in resistant hypertension

	Usefulness	Limitations
Medical treatment
Aldosterone antagonists	High prevalence of primary aldosteronism Higher efficacy than dual RAS blockade	70% of resistant-to-treatment hypertension cases are not controlled with ≥ 4 antihypertensive drugs
		Aldosterone antagonists cause frequent adverse effects, particularly in kidney disease
Sequential nephron/RAS blockade1	Act on sodium balance and RAS (major blood pressure determinants) Sequential nephron blockade superior to RAS blockade	Sequential blockade benefits need further validation Sequential nephron blockade regimen complexity Potential higher incidence of adverse effects/poor tolerance Needs regular medical evaluation
Device–based therapy
Catheter-based renal denervation	Novel therapeutic target for resistant to drug treatment patients Promising effects on glycemic control, sleep apnea and heart structure/function Potential benefits in heart failure patients	Needs further validation of study results Needs complete evaluation of delayed procedure complications Not available to all uncontrolled blood pressure patients Procedure success variability related to operator/patient factors
Carotid baroreflex activation	Novel therapeutic target for resistant to drug treatment patients	Needs further validation of study results Implantation's complexity and invasiveness

¹Added to triple antihypertensive treatment (ARB, thiazide, CCB). ARB: Angiotensin receptor blocker; CCB: Calcium channel blockers; RAS: Renin-angiotensin-aldosterone system.