Negative effects of chlorthalidone on sympathetic nervous system and insulin resistance in hypertensive patients may be avoided with spironolactone: further studies are still needed.

Chlorthalidone is commonly used for blood pressure control in hypertensive patients. However, it increases sympathetic nervous system activity and insulin resistance. Both conditions are related with an elevated number of complications and worsen patients' prognosis. Recently has been demonstrated that these adverse effects are avoided with spironolactone administration. Mechanisms to explain increasing sympathetic nervous activity and insulin resistance with chlorthalidone, but not with spironolactone are unclear and under investigation. It should be necessary to continue medical investigation on this field with long-term studies, a larger number of patients and associated comorbidities. The aim should be to establish whether the association of both drugs could be an effective and safety choice to be implemented extensively in clinical practice. That possibility could represent a new alternative for patients' management.

Renal denervation for treating resistant hypertension: current evidence and future insights from a global perspective.

Adequate blood pressure control represents an important goal for all physicians due to the complications of hypertension which reduce patients' quality of life. A new interventional strategy to reduce blood pressure has been developed for patients with resistant hypertension. Catheter-based renal denervation has demonstrated excellent results in recent investigations associated with few side effects. With the growing diffusion of this technique worldwide, some medical societies have published consensus statements to guide physicians how to best apply this procedure. Questions remain to be answered such as the long-term durability of renal denervation, the efficacy in patients with other sympathetically mediated diseases, and whether renal denervation would benefit patients with stage 1 hypertension.