New Approach in the Treatment of Resistant Arterial Hypertension Using Arteriovenous Anastomosis

Abstract

A novel approach for the treatment of resistant hypertension Interventional approaches to lower blood pressure such as baroreflex activation therapy and renal sympathetic denervation have been developed and tested clinically. These two approaches are based on sound pathophysiological concepts and target mechanisms highly relevant to the control of blood pressure and cardiovascular disease, although recent evidences shed some shadows on their effectiveness and large scale use in clinical practice. New interventional approaches based on different mechanisms are emerging. The ROX CONTROL HTN study is an open-label, multicenter, prospective randomised trial assessing the effects of creating a central arteriovenous anastomosis of 4 mm diameter between the distal iliac vein and artery with an arteriovenous coupler device. This arteriovenous anastomosis was associated with a significant and sustained reduction of both diastolic and systolic blood pressure values. Technical success of the procedure was assessed by an immediate drop in blood pressure after the creation of the anastomosis. The reduction of peripheral resistance could be the mechanisms of the blood lowering effect, although it was not directly tested in the study. In addition to the concern about the safety of this new interventional procedure, due to the elevated number of local side effects, the absence of adverse consequences of central arteriovenous anastomosis on cardiac output and central haemodynamics also need to be shown. This approach might be a useful adjunctive therapy for patients with uncontrolled hypertension.