Interventional procedure overview of alcohol-mediated perivascular renal sympathetic denervation for resistant hypertension

Unmet need

Hypertension remains a major cardiovascular risk factor, affecting approximately one-third of adults worldwide. Prevalence increases with age, rising to over 60% in people aged over 60 years. In the UK, hypertension is common and at least one quarter of adults (and more than half of those older than 60) have high BP. For resistant hypertension, NG136 acknowledges that its estimates vary, but it is generally thought to be about 5% of people with hypertension.

The risk associated with increasing BP is continuous, with each 2 mmHg rise in systolic BP associated with a 7% increased risk of mortality from ischaemic heart disease and 10% increased risk of mortality from stroke. So, lowering systolic and diastolic BP to recommended targets is associated with a substantial reduction in cardiovascular risk. Decrements in office systolic BP of 5 and 10 mmHg are associated with 10% and 20% reductions in cardiovascular disease events, respectively, and independent of other comorbidities.

However, hypertension management is challenging. Current pharmacological treatment regimens often fail to achieve adequate reductions in BP because of non-adherence to prescribed antihypertensive medications and lifestyle interventions. Due to the issue of highly variable adherence to medication, true treatment-resistant hypertension can be difficult to identify in clinical practice. So, hypertension because of lower or non-adherence to recommended medications can also be considered treatment-resistant (pseudo-resistant) and should be managed by a different treatment option (NG136). It is acknowledged that the concept of resistant hypertension is evolving (IPG754). So, to address the unmet need in the NHS, this assessment considers people with hypertension regardless of the number of antihypertensive medications prescribed.