Advances in Nonpharmacological Approaches, Such as Baroreceptor Stimulation, for the Treatment of Resistant Hypertension

Resistant hypertension (HTN) affects up to 20% of patients who fail to achieve blood pressure (BP) control despite standard triple-drug therapy. As pharmacological treatments remain inadequate for these patients, baroreflex activation therapy (BAT) has emerged as a promising nonpharmacological alternative. By electrically stimulating baroreceptors in the carotid sinus, BAT restores autonomic balance through increased parasympathetic and reduced sympathetic activity, resulting in substantial BP reductions. Modern implantable devices such as the Rheos® and BAROSTIM NEO® systems have demonstrated significant and sustained decreases in both systolic and diastolic BP in treatment-resistant HTN, as well as clinical benefits in heart failure and end-stage renal disease. Despite these advances, BAT remains limited by its surgical invasiveness, adverse effects, and narrow patient eligibility. Ongoing research aims to develop less invasive stimulation methods and refine patient selection criteria. Large-scale, randomized, double-blind trials are still needed to establish BAT’s long-term safety, efficacy, and clinical applicability. Overall, BAT represents an innovative, device-based therapeutic strategy for managing resistant hypertension.