Interventional Treatment of Secondary and Essential Hypertension

Systemic hypertension (HTN) is a major public health problem. India had 41.5 million people with HTN in 2000 and the burden is projected to increase by another 5 million by 2025.[1] HTN is divided in to primary and secondary and vast majority (≥90%) of cases belong to former group.[2] The management consists of lifestyle alterations along with judicious use of pharmacotherapy. A remedial cause of HTN, termed secondary can be identified in approximately 10% of cases. The treatment of specific cause can achieve normalization or better control of blood pressure (BP) with improved outcomes. Table 1 shows causes of secondary HTN amenable to surgical or percutaneous interventions. Various device-based therapies have emerged principally targeted at the treatment of resistant HTN. The therapeutic interventions used in secondary and essential HTN will be discussed in following subheads: 1. Endovascular renal interventions 2. Aortic interventions 3. Role of surgery 4. Renal denervation (RND). Endovascular Renal Interventions