- Uncontrolled hypertension affects 30-45% of the population and 10-15% have treatment resistant hypertension. Only 6 new drugs have been approved since 2001 to treat hypertension. - Future management may include telemonitoring blood pressure using mobile apps to engage patients. Interventional therapies like baroreceptor activation therapy, renal denervation, and ROX coupler implantation are being studied for resistant hypertension. - Chronotherapy using timed drug administration and endothelin receptor antagonists are also potential future strategies. Researchers are working on a vaccine against the renin-angiotensin system to control blood pressure long-term.

1. FUTURE OF HYPERTENSION
- Anirudhya J

2. Introduction
• Arterial hypertension is a controllable disease that affects
as much as 30-45 % of general population.
• The prevalence of treatment resistant hypertension has
been reported to be from 10-15 %
• Uncontrolled hypertension was found in 35.9 % of
patients of which 2.2 % were resistant.

3. Only 6 novel molecules have been approved by the FDA in this
millenium :
• Valsartan (2001)
• Eplerenone (2002) – Aldosterone receptor antagonist
• Olmesartan (2003)
• Aliskiren (2007) – Renin inhibitor – Lowers BP , reduces
albuminuria, limits LVH.
• Clevidipine (2008)
• Azilsartan medoxomil (2011)

4. Future paradigm in management
Telemonitoring of BP
Mobile health technology (mHealth) offers opprtunities to
support self-management behaviour, thereby actively engaging
patients in their care and reduce the number of office visits.

5. Interventional therapies
• May be considered in patients with resistant
hypertension.
1) Baroreceptor activation therapy:
- Carotid baroreceptors play a key role in BP
regulation and impairment in their function has been
associated with development and maintenance of
hypertension.

6. Continued…
- Chronic electrical stimulation of carotid sinus nerves via
implantable devices has shown significant reduction in BP.
- The Rheos Baroreflex activation therapy system was
used earlier.
- A modified version of this – Barostim neo system is a
second generation device for baroreflex activation
therapy.
- Adverse effects :
Infection, Nerve damage (Tongue paresis), Pain in
the glossopharyngeal nerve area, Shifting of the implanted
generator that required further surgery.

7. 2 ) Renal denervation :
- Renal sympathetic nerves contribute to both
development and maintenance of hypertension.
- Catheter based RDN has emerged as a potential
treatment modality for resistant hypertension.
- The procedure involves
catheter based ablation of
both afferent and efferent
nerves in the renal arteries.

8. Continued…
• The most futuristic of the RDN systems are non-invasive,
delivering externally focused ultrasound energy to the
renal nerves using Doppler-based ultrasound image
guidance to track and correct for renal artery motion
during treatment.

9. 3) ROX coupler :
- Another device based intervention for resistant
hypertension.
- The Coupler is surgically implanted between a vein and
an artery in the upper thigh.
- It acts on arterial compliance and vascular resistance to
reduce BP.

10. Chronotherapy
• A 69 % prevalence of nocturnal non-dipping has been
observed in patients with resistant hypertension.
• Non-dipping is partly related to the absence of
homogeneous 24 hour therapeutic coverage in patients
treated with single morning doses.
• A novel therapeutic strategy based on chronotherapy can
be adopted which involves a unique time of the
day for conventional drug administration.

11. Endothelin a receptor antagonists
• Endothelin is a potent vasoconstrictor and growth factor
and is commonly associated with renal disease.
• Selective ET receptor blockade has been shown to have
therapeutic potential in HTN, atherosclerosis, HF,
pulmonary disease and renal end organ damage.

12. Vaccines for hypertension
• Researchers are working on a vaccine against the
renin-angiotensin system to control hypertension.

13. Thank you