[Central arteriovenous anastomosis: the solution for patients with treatment-resistant hypertension?]

New non-pharmacological therapies for the treatment of resistant hypertension, such as baroreflex stimulation, renal denervation and barostenting, have recently been introduced. The latest development is lowering blood pressure by creating an arteriovenous anastomosis between the common iliac vein and artery by means of a metal coupler device. The randomised, non-blinded ROX CONTROL HTN study showed that office systolic blood pressure was reduced by 27 mmHg in patients assigned to arteriovenous coupler therapy, compared with a reduction of 4 mmHg in patients assigned to normal care. As this was not a double-blind, sham-controlled study, caution is needed. Complications related to the procedure or device were seen in 60% of patients in the intervention group. The most common complication was venous stenosis. Questions remain regarding the exact working mechanism, size and duration of the effects on blood pressure. There are also concerns about adverse effects.