Prof. Krzysztof Narkiewicz
Resistant hypertension affects a substantial proportion of treated hypertensives. The session “Novel targets in hypertension” focused on both device-based approaches and new drugs. Prof. Pathak (Toulouse, France) reviewed renal denervation procedures. Clinical evidence of long-term effectiveness and safety of this approach is limited to the Symplicity single-electrode radiofrequency catheter. Several novel technologies are currently being developed including (1) multiple-electrode radiofrequency catheters, such as the basket-design system, helical treatment and bipolar system; (2) ultrasound therapy and (3) hybrid techniques combining ablation with local drug delivery. Prof. Hasenfuss (Goettingen, Germany) presented the second generation baroreflex activation therapy (BAT). In contrast to first generation BAT requiring bilateral vascular surgery, the novel approach is unilateral and minimally invasive with a “pacemaker like” safety profile. The Barostim neo trial in patients with resistant hypertension has confirmed the hypotensive efficacy of second generation BAT, which is currently being tested in patients with CHF (NYHA III class). Prof. Grassi (Milan, Italy) reviewed vasopeptidase inhibitors offering dual inhibition of both ACE and neutral endopeptidase (NEP). Although earlier clinical trials (OCTAVE and OVERTURE) documented an increased risk of angioedema in omapatrilat-treated patients, which resulted in withdrawal of the drug from the market, there are ongoing efforts to develop new molecules from this class. Aldosterone synthase inhibitors were reviewed by Prof. McMurray (Glasgow, UK) who concluded that the role of this class is uncertain because of their relatively small hypotensive effect and partial inhibition of ACTH-stimulated cortisol response. In conclusion, the clinical development of new antihypertensive drugs is less productive than anticipated. The device-based approach is promising, but it should be currently limited to resistant hypertension. Furthermore, future studies will have to address the impact of renal denervation and baroreflex activation therapy on cardiovascular morbidity and mortality.
Novel targets in hypertension
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