Arterial hypertension is the most prevalent modifiable risk factor associated with cardiovascular morbidity and mortality. Although antihypertensive drugs are widely available, in many patients blood pressure control to guideline-recommended target values is not achieved. Several device-based approaches have been introduced to lower blood pressure; most of these strategies aim to modulate autonomic nervous system activity. Clinical trials have moved from including patients with resistant hypertension receiving intensive pharmacological treatment to including patients with mild-to-moderate hypertension in the presence or absence of antihypertensive medications. Renal sympathetic denervation is the most extensively investigated device-based therapy for hypertension, and randomized, sham-controlled trials have provided proof-of-principle data for its blood pressure-lowering efficacy. Unilateral electrical baroreflex activation, endovascular baroreflex amplification and pacemaker-mediated cardiac neuromodulation therapy have yielded promising results in observational trials, which need to be confirmed in larger, adequately powered, sham-controlled trials. Until further evidence becomes available, device-based therapy for hypertension should not be considered for routine treatment. However, when considering a device-based treatment for hypertension, the underlying pathophysiology in each patient has to be taken into consideration, and the procedural risks weighed against the cardiovascular risk attributable to the elevated blood pressure. This Review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for hypertension.

动脉高血压是与心血管疾病和死亡率相关的最普遍的可改变危险因素。尽管降压药广泛可用，但在许多患者中，仍未达到将血压控制到指导性推荐目标值的目的。已经引入了几种基于设备的方法来降低血压。这些策略中的大多数旨在调节植物神经系统的活动。临床试验已经从包括接受强化药理治疗的耐药性高血压患者转变为包括存在或不存在抗高血压药物的轻度至中度高血压患者。肾交感神经去神经支配术是研究最广泛的基于器械的高血压治疗方法，随机，假对照试验为其降压功效提供了原理数据。单侧电压力反射激活，血管内压力反射放大和起搏器介导的心脏神经调节治疗已在观察性试验中产生了令人鼓舞的结果，需要在较大的，有足够动力的假手术对照试验中加以证实。在没有进一步的证据可用之前，不应考虑将基于设备的高血压疗法用于常规治疗。但是，在考虑基于设备的高血压治疗时，必须考虑到每个患者的潜在病理生理，并且将程序风险与高血压引起的心血管风险进行权衡。