Interview with Sverre Kjeldsen and Felix Mahfoud
What is the philosophy and guiding spirit behind this Course for you both?
Hypertension is the most common and important risk factor for morbidity and mortality worldwide and the problems posed by hypertension continue to increase. While most people presenting with hypertension today are successfully treated with well-tolerated blood pressure (BP) lowering drugs – usually in combinations – approximately 10% of all hypertensives have what is called “treatment resistant hypertension”. This group of “treatment resistant hypertension” hypertensives have the poorest prognosis.
Over the past few years, new treatment modalities have emerged that may successfully control the high BP in many of these patients. Among these new techniques and treatments, renal denervation (RDN), baroreceptor activation stimulation (BAT) and other device interventions that interfere with the autonomic nervous system, have successfully contributed to major improvements in the care of this challenging group of hypertensive patients.
What is the imperative, if there is one, to better understand the nature – and eventual treatment – of resistant hypertension?
New treatment modalities extensively stimulate more research into the aetiology, pathophysiology, diagnostic work-up and treatment of patients with treatment resistant hypertension. The progress witnessed by the technical development of RDN, BAT and, in general, vagal stimulation, have greatly contributed to a better understanding of the role of the autonomic nervous system in the short- and long-term control of blood pressure.
Concomitantly, progress in these areas has forced us to look more deeply than ever before into the causes of secondary hypertension, possible spurious hypertension, as well as encouraging the development of better diagnostic tools for the detection of target organ damage. Today, as well, we must take into consideration the important and key aspects of a specific patient’s behaviour, including their psychological state, which can lead certain individuals to neglect the need for treatment or to be poor drug compliant.
For the first time we are seeing that developments in our treatment and understanding of hypertension are inspiring ongoing and substantial research to help the approximately 10% of the population that are severe hypertensives.
What is the different understanding and approach to resistant hypertension as characterised by a hypertension specialist or an interventionalist?
Hypertension is a complex disease and its overall care involves extensive knowledge and experience in epidemiology, physiology, pathophysiology, diagnostic work-up, along with an understanding of the methodologies used in cardiology, nephrology, endocrinology and other disciplines of internal medicine, as well as detailed knowledge of clinical pharmacology for the management these patients.
The specific role of the Interventionalist in the care of these patients is exciting, but today represents just a fraction of the overall treatment for hypertension as it is currently limited to patients with true treatment resistant hypertension. With further research and development, larger patient groups could possibly be included in the sphere of the interventionalist, but before these new interventional methods can be offered as routine clinical options, prospective and randomised studies and trials must prove the benefits for these patient groups of their use.