Blood pressure management in clinically complex scenarios: new horizons for a tailored approach

Arterial hypertension is a major preventable cardiovascular risk factor, which is estimated to be responsible of around 25% of heart attacks and 40% of cardiovascular deaths in Europe. As the prevalence of arterial hypertension is continuously growing in the general population, it is estimated that by 2025 up to 60% of the adult western population will suffer from high blood pressure (BP), making arterial hypertension a timely topic for scientific research. The management of BP in specific conditions such as heart failure, kidney diseases or paediatric patients could be challenging. In the last years, new drugs have been introduced, changing the landscape of heart failure treatment, while possibly having a significant impact on BP regulation and kidney function. Similarly, while resistant hypertension may represent a true issue for clinicians and patients, novel therapeutic approaches are now available. In this regard, while for instance renal artery denervation has been introduced as an innovative therapy for patients with resistant hypertension, it has possibly shown consistent benefits also in patients with heart failure at large, whereby it could significantly reduce sympathetic nervous activation. This review focuses on new perspectives for the management of BP in these specific populations in order to provide practical hints for a tailored approach for clinically complex and/or resistant patients.