When Hypertension Defies Control

In the majority of cases, hypertension can be effectively managed through lifestyle modifications and appropriate medication. However, there are rare instances when blood pressure remains uncontrolled despite these efforts.

In such cases, specialized treatments and invasive interventions may be considered to address the challenges of uncontrolled hypertension. This article aims to provide a brief overview of these advanced treatment options for individuals with resistant hypertension.

What is Resistant Hypertension:

Resistant hypertension is a condition where blood pressure remains persistently high despite the use of multiple antihypertensive medications.

It is estimated that approximately 10-20% of individuals with hypertension may have resistant hypertension. For these individuals, achieving blood pressure control becomes more challenging and requires additional interventions beyond lifestyle adjustments and standard medications.

Specialized Treatments:

When hypertension defies control despite lifestyle modifications and adherence to medication, specialized centers exist that offer advanced treatment options. These interventions are considered in very rare cases and require careful assessment and patient selection. Two notable invasive interventions for resistant hypertension are renal denervation and carotid baroreceptor stimulation.

  • Renal Denervation: Renal denervation is a procedure that involves disrupting the nerve signals to the kidneys, which play a role in regulating blood pressure. It is typically performed by an interventional cardiologist or radiologist using specialized catheters. During the procedure, radiofrequency energy or ultrasound is used to selectively destroy the nerves in the renal arteries. By interrupting these nerve signals, renal denervation aims to lower blood pressure.
  • Carotid Baroreceptor Stimulation: Carotid baroreceptor stimulation is another invasive approach that targets the baroreceptors located in the carotid arteries. These baroreceptors sense changes in blood pressure and send signals to the brain to regulate it. Carotid baroreceptor stimulation involves the implantation of a device that delivers electrical impulses to the baroreceptors, modulating their activity and lowering blood pressure.

Considerations and Patient Selection:

It is important to note that these specialized treatments are reserved for exceptional cases when other treatment options have been exhausted or are not suitable.

Renal denervation and carotid baroreceptor stimulation require expertise and are performed in specialized centers by experienced healthcare professionals. Patient selection is critical, as these procedures are not appropriate for everyone with uncontrolled hypertension.

These invasive interventions carry potential risks and complications, including procedural risks, device-related issues, and potential adverse effects. Patients undergoing these treatments require close monitoring and ongoing follow-up care to ensure safety and optimize outcomes.

Future Directions:

While renal denervation and carotid baroreceptor stimulation show promise as potential interventions for resistant hypertension, ongoing research is essential to evaluate their long-term effectiveness, safety profiles, and patient outcomes.

Advances in technology and a deeper understanding of the underlying mechanisms of resistant hypertension may lead to the development of more targeted and effective treatment options in the future.


For the vast majority of individuals with hypertension, lifestyle adjustments and medication adherence result in successful blood pressure control.

However, in extremely rare cases where blood pressure defies control despite these measures, specialized treatments and invasive interventions such as renal denervation and carotid baroreceptor stimulation may be considered. These advanced treatment options are available in specialized centers and require careful patient selection and monitoring.

Ongoing research and advancements in the field will continue to enhance our understanding of resistant hypertension, leading to the development of novel treatment approaches in the future.


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About Dr Adrian Mondry

Dr Adrian Mondry is a Hypertension Specialist accredited by the German Hypertension League in Singapore. He was previously a senior consultant in the department of medicine at the National University Hospital and Ng Teng Fong General Hospital (NTFGH), Dr Mondry has more than 30 years of experience in the field of internal medicine.

Dr Adrian Mondry is recognised for his leadership and contributions in establishing the dedicated hypertension clinic within the National University Health System and fast-track deep vein thrombosis service at NTFGH.

Dr Adrian Mondry is fluent in English, German and French.

About Kaizen Medical

Kaizen Medical is located at Mount Elizabeth Novena Specialist Centre, Suite 11-57.

At Kaizen, we provide in depth health care to patients with multi-organs diseases; tackling undifferentiated presentations that cannot be easily assigned to a single organ.

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