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Treating Hypertension in Older People Recent Advances in Geriatric Medicine, Vol. 1 39
The Hypertension in the Very Elderly Trial (HYVET) randomized 3845 patients
aged 80 years and above with SBP ≥160 mmHg to antihypertensive therapy or
double-blind placebo [14]. The target BP was 150/80 mmHg. After a median
follow-up of 1.8 years, participants in the antihypertensive group had a 21%
reduction in all-cause mortality, a 30% reduction in fatal or nonfatal stroke, a 23%
reduction in CV death and a 64% reduction in heart failure [14]. The NNT over
2.1 years to prevent one death is 46 patients. The study was terminated early
because a statistically significant reduction in all-cause mortality in the active
group was achieved. An important consideration of the HYVET study is that the
study population was healthier than the typical older patients. For example, in
HYVET, 12% of participants had a history of CV disease compared with 20.8%
of women and 35.5% of men aged 80 years and above in the US [4].
The Systolic Hypertension in Europe (Syst-Eur) study randomized 4695 patients
with a mean age of 70.3 years with isolated systolic hypertension to
antihypertensive therapy or placebo [18]. Participants were followed up for a
median of 2 years. Mean reduction in BP of 23/7 mmHg was observed in the drug
therapy group compared to 13/2 mmHg in the placebo group. All-cause mortality
was not significantly reduced but fatal and nonfatal strokes were reduced by 42%
[18]. Fatal and nonfatal CV events were reduced by 31% [18].
Another study on systolic hypertension in China (Syst-China) alternately assigned
2394 participants with a mean age of 66.5 years to antihypertensive therapy or
placebo [19]. After a mean follow-up period of 3 years, BP was reduced by
10.9/1.9 mmHg in the placebo group compared to 20.0/5.0 mmHg in the drug
therapy group. In the drug therapy group, all-cause mortality was reduced by
39%, all strokes by 38%, CV mortality by 39% and stroke mortality by 58% [19].
MANAGEMENT – LIFESTYLE MODIFICATIONS
Lifestyle measures should be encouraged both to prevent the onset of
hypertension and as an adjunct intervention in those with hypertension. In a meta-
analysis of 56 randomized controlled trials, a mean BP reduction of 3.7/0.9
mmHg can be achieved in older hypertensive individuals with a reduction of 100
mmol/day in urinary sodium excretion, a proxy measure of dietary sodium intake
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40 Recent Advances in Geriatric Medicine, Vol. 1 Wu and Khow
[20]. Current guidelines recommend no more than 2300 mg of sodium (or 6 g of
sodium chloride daily) to no more than 1500 mg of sodium daily in older people,
or those with hypertension, diabetes mellitus and chronic kidney disease [1]. In a
study of 1981 Taiwanese veterans with a mean age of 75 years, participants were
randomized to a regular salt diet or to a potassium-enriched salt diet with 50% less
sodium [21]. Follow-up at 31 months found CV mortality to be reduced by 41%
in the group receiving potassium-enriched and sodium-reduced diet.
In addition to dietary sodium restriction, adopting the Dietary Approaches to Stop
Hypertension, known as the DASH eating plan (diet rich in fruits, vegetables and
low-fat dairy products but low in saturated and total fat), increased physical
activity and moderation of alcohol intake (less than the equivalent of two standard
drinks per day for men and one for women) have been shown to reduce BP and
improve other CV risk factors [22].
MANAGEMENT – PHARMACOLOGICAL TREATMENT
The five main classes of antihypertensive drugs that may be used as initial therapy
for primary hypertension in older people are angiotensin-converting enzyme
(ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, calcium
channel antagonists, and diuretics. A meta-analysis of 147 randomized trials
including 464,000 adults with hypertension revealed that all five classes of
antihypertensives have a similar reduction in acute coronary events and ischaemic
strokes for a given decrease in BP [23]. Regardless of pre-treatment BP and the
presence or absence of previous CV events, the proportionate decrease in CV
events was similar in this meta-analysis [23]. Extra protective effect when beta-
blockers were given after myocardial infarction and a minor additional effect in
preventing strokes were observed.
The selection of specific antihypertensive drugs in older people depends on
efficacy, tolerability, presence of comorbidities and cost (Table 2). For patients
with hypertension and diabetes mellitus, ACE inhibitor or ARB should be
included in the absence of contraindications [24]. In the setting of chronic kidney
disease with or without diabetes mellitus, an ACE inhibitor or ARB should be
used [25]. Beta-blockers should be used to treat older people with complex
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Treating Hypertension in Older People Recent Advances in Geriatric Medicine, Vol. 1 41
ventricular arrhythmias, heart failure after stabilization of acute symptoms, angina
pectoris, previous myocardial infarction, supraventricular tachyarrhythmias such
as atrial fibrillation, hyperthyroidism, preoperative hypertension or essential
tremor [26]. For older patients with hypertension and heart failure, ACE
inhibitors, beta-blockers and diuretics are usually used as well as aldosterone
antagonists if required [27]. Calcium channel antagonists and diuretics are
preferred in older patients with isolated hypertension [15].
Table 2. Choice of antihypertensives in the treatment of hypertension in the setting of coexisting
medical conditions.
ACE
Inhibitors
ARBs Beta-Blockers
Calcium Channel
Antagonists
a
Diuretics
Prior myocardial infarction or
angina pectoris
+ +
Heart failure + + + +
Rapid atrial fibrillation + +
Diabetes mellitus + +
Chronic kidney disease
b
+ +
ACE: Angiotensin-converting enzyme, ARB: Angiotensin receptor blocker
a
Non-dihydropyridine
b
With or without diabetes mellitus
The choice of antihypertensive drug to use in older people is not well studied.
Older people often have coexisting medical conditions, are taking multiple
medications and are more prone to drug interactions which may limit the ability to
achieve BP targets [28].
MANAGEMENT OF RESISTANT HYPERTENSION
Data from retrospective cross-sectional population studies of BP control in Spain
and the US indicate prevalence of resistant hypertension was 7.6-8.9% [29, 30].
Post-hoc analysis of data from large clinical trials of antihypertensive therapy
such as ALLHAT, ASCOT and ACCOMPLISH indicate that the prevalence could
be as high as 35% [31 - 33]. Before the diagnosis of resistant hypertension is
made, pseudo-resistant hypertension must be excluded. Pseudo-resistant
hypertension may arise from incorrect BP measurement technique, the “white-
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42 Recent Advances in Geriatric Medicine, Vol. 1 Wu and Khow
coat” effect, lack of patient adherence to prescribed treatment or suboptimal
antihypertensive therapy.
Resistant hypertension can be caused by potentially remediable secondary
aetiologies such as renal artery stenosis, chronic kidney disease (either as the
cause or consequence of chronic poorly-controlled hypertension),
hyperaldosteronism and obstructive sleep apnoea (Table 3).
Table 3. Common secondary causes of resistant hypertension and their relevant features.
Secondary Cause Features
Renal artery stenosis Carotid, renal or femoral bruits, flash pulmonary oedema, young females
(fibromuscular dysplasia), history of atherosclerotic disease
Renal parenchymal disease Albuminuria/proteinuria, microscopic haematuria, biochemical disturbances,
peripheral oedema
Primary hyperaldosteronism Hypokalaemia, low renin levels despite taking medications that would be
expected to raise renin levels, raised aldosterone levels
Obstructive sleep apnoea
Obesity, short neck, daytime sleepiness, snoring, frequent night-time
awakenings, witnessed apnoea
In older patients with resistant hypertension despite use of three different classes
of antihypertensive agents, some data support the use of spironolactone as a fourth
drug if the potassium is ≤4.5 mmol/L [34]. Spironolactone inhibits the action of
aldosterone at the mineralocorticoid receptor, which results in natriuresis and
reduction of fluid overload. The main long-term adverse effect of spironolactone
is breast tenderness and gynaecomastia. It is usually reversible when the drug is
stopped. Hyperkalaemia is a risk when using spironolactone in patients with
resistant hypertension who are already taking an ACE inhibitor or ARB especially
in those with chronic kidney disease or diabetes mellitus [35]. Therefore
potassium concentration should be checked within two weeks of drug initiation
and further monitoring depending on index result and dose adjustment.
Hyponatraemia may also develop with long-term use, especially in older patients
and when used in combination with pre-existing diuretic therapy [35]. Centrally
acting α agonist such as methyldopa or vasodilators like hydralazine or minoxidil
are further options.
There is growing interest in the use of devices to manage resistant hypertension so
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Treating Hypertension in Older People Recent Advances in Geriatric Medicine, Vol. 1 43
that BP control can be achieved without adding more medications. Two
techniques are being assessed: percutaneous transluminal radiofrequency
sympathetic denervation of the renal artery [36 - 38] and carotid baroreflex
activation [39]. The Symplicity HTN-1 and HTN-2 trials have demonstrated
significant BP decline in response to renal denervation, in the magnitude of 30/15
mmHg and maintained beyond two years of extended follow-up [36, 38]. These
participants continued to require antihypertensive therapy but at a reduced number
or dose in some patients. However, the Symplicity HTN-3 study has shown that
the renal denervation group and the sham-group had similar reductions in BP [37,
40]. In older people with resistant hypertension, renal denervation has not been
found to be more effective than a sham operation in reducing BP [37, 40].
CHALLENGES OF HYPERTENSION MANAGEMENT IN OLDER
PEOPLE
Older people are undertreated for hypertension [1]. Medical professionals must
recognise that “clinical inertia” is an important contributor to the inadequate
management of hypertension in older people especially when patients require
multiple antihypertensive medications. This clinical inertia can encompass a lack
of knowledge about clinical guidelines, a misguided acceptance of high BP
measurements or an underestimation of CV diseases risk, resulting in suboptimal
treatment of hypertension [41].
While the benefit for intensive BP control has been validated in older people
between the age of 65 and 80 years, evidence is lacking for the older patients,
those aged above 80 years. There is a paucity of data to direct therapy in the
population aged >80 years along with concerns raised by epidemiological studies
regarding BP targets [42, 43].
Postural hypotension should be evaluated in all older people on antihypertensive
treatment by measuring their BP with them standing for 1-3 min. Postural
hypotension is defined as a drop in SBP of ≥20 mmHg or DBP of ≥10 mmHg
within 3 min of standing. In a study of long-term residents of a health care
facility, postural hypotension occurred in 13% of patients receiving CV or
psychotropic drugs compared to 3% (p <0.001) in those not receiving these drugs
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44 Recent Advances in Geriatric Medicine, Vol. 1 Wu and Khow
[44]. Of major concerns, postural hypotension can lead to syncope, falls and
potentially fractures.
Although low-dose diuretic was found to be beneficial in the HYVET study,
higher doses of diuretics are associated with more electrolyte disorders such as
hyponatraemia which can have significant consequences in older people [35].
This can be avoided by starting diuretics at a low dose and avoiding concurrent
use of medications that can also predispose to hyponatraemia.
Poor adherence to antihypertensive therapy in the older population is another
important consideration in BP control. As a result careful monitoring of adherence
is essential in optimizing hypertension management. Factors that adversely affect
adherence to treatment include patients’ low level of education, the presence of
coexisting diseases and complex medication regimens [45].
CONCLUSION
Our population is aging, and as most elderly people (≥65 years of age) are
affected by hypertension, these individuals are more likely to have organ damage
or clinical CVD. They major management dilemmas because most hypertension
trials had upper age limits during recruitment or did not present age-specific
results. Because the lack of information for evidence-based guidelines to manage
older patients with hypertension, recommendations in this chapter are based on
expert opinion which still provides a reasonable clinical approach. Drug treatment
for elderly hypertensive patients has been generally recommended but with a
greater degree of caution due to alterations in drug pharmacokinetics and
pharmacodynamics with increasing age. Within the limitations of individual
patient characteristics such as limited life expectancy, adverse effects of
medications and coexisting diseases, treatment of hypertension is still generally
beneficial among older people.
CONFLICT OF INTEREST
The author confirms that author has no conflict of interest to declare for this
publication.
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Treating Hypertension in Older People Recent Advances in Geriatric Medicine, Vol. 1 45
ACKNOWLEDGEMENTS
Declared none.
KEY POINTS
Hypertension commonly affects older people (>65 years of age).
●
Strong evidence that better blood pressure control reduces cardiovascular
●
diseases and stroke in older people in the age group of 65-80 years.
Evidence that tight blood pressure control in those aged 80 years or above
●
significantly reduces cardiovascular diseases and stroke is not as strong.
The choice of specific antihypertensive drugs in older people depends on
●
efficacy, tolerability, presence of comorbidities and cost.
Challenges in management of hypertension in older people may include clinical
●
inertia, polypharmacy, coexisting diseases and postural hypotension.
REFERENCES
[1] Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension
in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical
Expert Consensus documents developed in collaboration with the American Academy of Neurology,
American Geriatrics Society, American Society for Preventive Cardiology, American Society of
Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European
Society of Hypertension. J Am Coll Cardiol 2011; 57(20): 2037-114.
[http://dx.doi.org/10.1016/j.jacc.2011.01.008] [PMID: 21524875]
[2] Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A
scientific statement from the American Heart Association Professional Education Committee of the
Council for High Blood Pressure Research. Hypertension 2008; 51(6): 1403-19.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.189141] [PMID: 18391085]
[3] Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results
from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995;
25(3): 305-13.
[http://dx.doi.org/10.1161/01.HYP.25.3.305] [PMID: 7875754]
[4] Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics--2009 update: a
report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
Circulation 2009; 119(3): e21-e181.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.191261] [PMID: 19075105]
[5] Aronow WS, Ahmed MI, Ekundayo OJ, Allman RM, Ahmed A. A propensity-matched study of the
association of peripheral arterial disease with cardiovascular outcomes in community-dwelling older
adults. Am J Cardiol 2009; 103(1): 130-5.
[http://dx.doi.org/10.1016/j.amjcard.2008.08.037] [PMID: 19101243]
https://t.me/med1917
46 Recent Advances in Geriatric Medicine, Vol. 1 Wu and Khow
[6] Yambe M, Tomiyama H, Yamada J, et al. Arterial stiffness and progression to hypertension in
Japanese male subjects with high normal blood pressure. J Hypertens 2007; 25(1): 87-93.
[http://dx.doi.org/10.1097/01.hjh.0000254375.73241.e2] [PMID: 17143178]
[7] Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness.
Arterioscler Thromb Vasc Biol 2005; 25(5): 932-43.
[http://dx.doi.org/10.1161/01.ATV.0000160548.78317.29] [PMID: 15731494]
[8] Lind L. Systolic and diastolic hypertension impair endothelial vasodilatory function in different types
of vessels in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS)
study. J Hypertens 2006; 24(7): 1319-27.
[http://dx.doi.org/10.1097/01.hjh.0000234112.38863.6f] [PMID: 16794481]
[9] James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high
blood pressure in adults: report from the panel members appointed to the Eighth Joint National
Committee (JNC 8). JAMA 2014; 311(5): 507-20.
[http://dx.doi.org/10.1001/jama.2013.284427] [PMID: 24352797]
[10] Spence JD, Sibbald WJ, Cape RD. Pseudohypertension in the elderly. Clin Sci Mol Med Suppl 1978;
4: 399s-402s.
[PMID: 282097]
[11] Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic
hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991;
265(24): 3255-64.
[http://dx.doi.org/10.1001/jama.1991.03460240051027] [PMID: 2046107]
[12] Kostis JB, Davis BR, Cutler J, et al. Prevention of heart failure by antihypertensive drug treatment in
older persons with isolated systolic hypertension. JAMA 1997; 278(3): 212-6.
[http://dx.doi.org/10.1001/jama.1997.03550030052033] [PMID: 9218667]
[13] Perry HM Jr, Davis BR, Price TR, et al. Effect of treating isolated systolic hypertension on the risk of
developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program
(SHEP). JAMA 2000; 284(4): 465-71.
[http://dx.doi.org/10.1001/jama.284.4.465] [PMID: 10904510]
[14] Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or
older. N Engl J Med 2008; 358(18): 1887-98.
[http://dx.doi.org/10.1056/NEJMoa0801369] [PMID: 18378519]
[15] Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial
hypertension: the Task Force for the management of arterial hypertension of the European Society of
Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31(7):
1281-357.
[http://dx.doi.org/10.1097/01.hjh.0000431740.32696.cc] [PMID: 23817082]
[16] Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated and treated isolated systolic hypertension
in the elderly: meta-analysis of outcome trials. Lancet 2000; 355(9207): 865-72.
[http://dx.doi.org/10.1016/S0140-6736(99)07330-4] [PMID: 10752701]
[17] Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester PO. Morbidity and mortality in
https://t.me/med1917
Treating Hypertension in Older People Recent Advances in Geriatric Medicine, Vol. 1 47
the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338(8778):
1281-5.
[http://dx.doi.org/10.1016/0140-6736(91)92589-T] [PMID: 1682683]
[18] Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active
treatment for older patients with isolated systolic hypertension. Lancet 1997; 350(9080): 757-64.
[http://dx.doi.org/10.1016/S0140-6736(97)05381-6] [PMID: 9297994]
[19] Liu L, Wang JG, Gong L, Liu G, Staessen JA. Comparison of active treatment and placebo in older
Chinese patients with isolated systolic hypertension. J Hypertens 1998; 16(12 Pt 1): 1823-9.
[http://dx.doi.org/10.1097/00004872-199816120-00016] [PMID: 9869017]
[20] Midgley JP, Matthew AG, Greenwood CM, Logan AG. Effect of reduced dietary sodium on blood
pressure: a meta-analysis of randomized controlled trials. JAMA 1996; 275(20): 1590-7.
[http://dx.doi.org/10.1001/jama.1996.03530440070039] [PMID: 8622251]
[21] Chang HY, Hu YW, Yue CS, et al. Effect of potassium-enriched salt on cardiovascular mortality and
medical expenses of elderly men. Am J Clin Nutr 2006; 83(6): 1289-96.
[PMID: 16762939]
[22] Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood
pressure. N Engl J Med 1997; 336(16): 1117-24.
[http://dx.doi.org/10.1056/NEJM199704173361601] [PMID: 9099655]
[23] Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of
cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from
prospective epidemiological studies. BMJ 2009; 338: b1665.
[http://dx.doi.org/10.1136/bmj.b1665]
[24] Standards of medical care in diabetes--2013. Diabetes Care 2013; 36 (Suppl. 1): S11-66.
[http://dx.doi.org/10.2337/dc13-S011] [PMID: 23264422]
[25] Wheeler DC, Becker GJ. Summary of KDIGO guideline. What do we really know about management
of blood pressure in patients with chronic kidney disease? Kidney Int 2013; 83(3): 377-83.
[http://dx.doi.org/10.1038/ki.2012.425] [PMID: 23325075]
[26] Aronow WS. Current role of beta-blockers in the treatment of hypertension. Expert Opin
Pharmacother 2010; 11(16): 2599-607.
[http://dx.doi.org/10.1517/14656566.2010.482561] [PMID: 20426702]
[27] Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart
failure: a report of the American College of Cardiology Foundation/American Heart Association Task
Force on Practice Guidelines. J Am Coll Cardiol 2013; 62(16): e147-239.
[http://dx.doi.org/10.1016/j.jacc.2013.05.019] [PMID: 23747642]
[28] Butt TF, Branch RL, Beesley L, Martin U. Managing hypertension in the very elderly: effect of
adverse drug reactions (ADRs) on achieving targets. J Hum Hypertens 2010; 24(8): 514-8.
[http://dx.doi.org/10.1038/jhh.2009.116] [PMID: 20130597]
[29] de la Sierra A, Segura J, Banegas JR, et al. Clinical features of 8295 patients with resistant
hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension 2011;
57(5): 898-902.
https://t.me/med1917
48 Recent Advances in Geriatric Medicine, Vol. 1 Wu and Khow
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.110.168948] [PMID: 21444835]
[30] Persell SD. Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension 2011;
57(6): 1076-80.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.111.170308] [PMID: 21502568]
[31] Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme
inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment
to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288(23): 2981-97.
[http://dx.doi.org/10.1001/jama.288.23.2981] [PMID: 12479763]
[32] Gupta AK, Nasothimiou EG, Chang CL, Sever PS, Dahlöf B, Poulter NR. Baseline predictors of
resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to
identify those at high-risk. J Hypertens 2011; 29(10): 2004-13.
[http://dx.doi.org/10.1097/HJH.0b013e32834a8a42] [PMID: 21881528]
[33] Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for
hypertension in high-risk patients. N Engl J Med 2008; 359(23): 2417-28.
[http://dx.doi.org/10.1056/NEJMoa0806182] [PMID: 19052124]
[34] Chapman N, Dobson J, Wilson S, et al. Effect of spironolactone on blood pressure in subjects with
resistant hypertension. Hypertension 2007; 49(4): 839-45.
[http://dx.doi.org/10.1161/01.HYP.0000259805.18468.8c] [PMID: 17309946]
[35] Khow KS, Lau SY, Li JY, Yong TY. Diuretic-associated electrolyte disorders in the elderly: risk
factors, impact, management and prevention. Curr Drug Saf 2014; 9(1): 2-15.
[http://dx.doi.org/10.2174/1574886308666140109112730] [PMID: 24410347]
[36] Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure
reduction out to 24 months. Hypertension 2011; 57(5): 911-7.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.110.163014] [PMID: 21403086]
[37] Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant
hypertension. N Engl J Med 2014; 370(15): 1393-401.
[http://dx.doi.org/10.1056/NEJMoa1402670] [PMID: 24678939]
[38] Esler MD, Krum H, Schlaich M, Schmieder RE, Böhm M, Sobotka PA. Renal sympathetic
denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2
randomized, controlled trial. Circulation 2012; 126(25): 2976-82.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.112.130880] [PMID: 23248063]
[39] Alnima T, Kroon AA, de Leeuw PW. Baroreflex activation therapy for patients with drug-resistant
hypertension. Expert Rev Cardiovasc Ther 2014; 12(8): 955-62.
[http://dx.doi.org/10.1586/14779072.2014.931226] [PMID: 25017430]
[40] Bakris GL, Townsend RR, Liu M, et al. Impact of renal denervation on 24-hour ambulatory blood
pressure: results from SYMPLICITY HTN-3. J Am Coll Cardiol 2014; 64(11): 1071-8.
[http://dx.doi.org/10.1016/j.jacc.2014.05.012] [PMID: 24858423]
[41] Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician-related
barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002; 162(4):
413-20.
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