High blood pressure affects over 14 million adults in the UK and is the single biggest risk factor for preventable death worldwide. Despite dozens of available medications, blood pressure remains uncontrolled in nearly 40% of treated patients. A new wave of trials is tackling resistant hypertension with renal denervation, device-based therapies, and precision medicine approaches.
The UK has a strong tradition in hypertension research — the MRC trial of bendrofluazide in the 1980s changed global practice, and British researchers continue to lead. NICE updated its hypertension guidelines in 2024, and the British and Irish Hypertension Society (BIHS) actively supports clinical trials.
Currently, there are over 120 actively recruiting hypertension trials in the UK, spanning pharmacology, interventional cardiology, device therapy, and digital health. The focus has shifted from "which drug?" to "which approach for which patient?" — precision hypertension management.
Types of Hypertension Trials
Renal Denervation
Catheter-based radiofrequency or ultrasound ablation of renal sympathetic nerves for resistant and uncontrolled hypertension.
Novel Medications
Aldosterone synthase inhibitors, dual-acting agents, and long-acting formulations targeting new pathways beyond RAAS blockade.
Device Therapies
Implantable and wearable devices including carotid baroreceptor stimulation and arteriovenous couplers for blood pressure reduction.
Digital Health
Remote monitoring, AI-driven medication titration, and behavioural interventions for sustained blood pressure control.
Renal Denervation
Renal denervation (RDN) is the most significant interventional development in hypertension in decades. After early controversy, the technique has matured with better patient selection and catheter technology:
Radiofrequency RDN — the Symplicity Spyral system (Medtronic) and similar devices using radiofrequency energy to ablate renal sympathetic nerves, now in large UK trials after positive sham-controlled data
Ultrasound RDN — the Paradise system (ReCor Medical) using ultrasound energy for circumferential renal nerve ablation, potentially more complete denervation
Alcohol-mediated RDN — perivascular injection of alcohol for targeted nerve destruction, a newer approach in early UK trials
RDN in medication-naïve patients — trials testing whether RDN can be offered as a first-line alternative to daily medication
RDN with ambulatory blood pressure monitoring — studies using 24-hour ABPM as the primary endpoint to capture true blood pressure reduction
Novel Antihypertensive Agents
Beyond the standard ACE inhibitors, ARBs, calcium channel blockers, and thiazides, new drug classes are entering trials:
Aldosterone synthase inhibitors (ASI) — lorundrostat and other ASIs blocking aldosterone production at source, targeting resistant hypertension driven by aldosterone excess
Non-steroidal mineralocorticoid receptor antagonists — finererenone and esaxerenone offering mineralocorticoid blockade with lower hyperkalaemia risk than spironolactone
Endothelin receptor antagonists — aprocitentan, the first endothelin receptor antagonist approved for resistant hypertension, now in UK post-marketing studies
Vasopressin V2 receptor antagonists — exploring vaptans for hypertension with fluid overload components
Long-acting single-pill combinations — polypill trials with 3–4 antihypertensives in a single tablet to improve adherence
Device-Based Therapies
Beyond renal denervation, other device approaches are being studied:
Carotid baroreceptor stimulation — implantable devices electrically stimulating baroreceptors in the carotid sinus to reduce sympathetic nervous system activity
Arteriovenous couplers — creating a small AV fistula (ROX Medical coupler) to reduce peripheral resistance through central compliance effects
Central iliac arteriovenous anastomosis — larger AV coupler devices for severe resistant hypertension
Digital health is transforming hypertension management from episodic surgery-based measurement to continuous data-driven care:
AI-driven medication titration — algorithms recommending medication dose adjustments based on home blood pressure readings, trialled against standard physician-guided titration
Remote monitoring platforms — NHS-supported trials of home blood pressure monitoring with automated clinician alerts for readings exceeding targets
Wearable blood pressure monitors — cuffless and wrist-worn devices providing continuous or near-continuous blood pressure data, validated against standard measurements
Behavioural interventions — app-based dietary sodium reduction, exercise prescription, stress management, and medication adherence support
Telemedicine blood pressure clinics — virtual hypertension clinics comparing outcomes with traditional face-to-face review
Resistant Hypertension
Resistant hypertension (blood pressure uncontrolled on 3+ drugs including a diuretic) affects 10–15% of treated patients and is a major research priority:
Spironolactone vs. RDN head-to-head — UK trials directly comparing the effectiveness of aldosterone antagonism versus renal denervation in resistant hypertension
Aldosterone excess screening — trials of universal screening for primary aldosteronism in resistant hypertension, which may be present in up to 20% of cases
Adherence monitoring — studies using urine drug metabolite testing and digital pill bottles to distinguish true resistance from non-adherence
Combination device and drug approaches — trials combining RDN with novel medications for synergistic blood pressure reduction
Who Can Participate?
Eligibility depends on the trial type and severity of hypertension:
Medication trials — confirmed diagnosis of hypertension (clinic BP ≥140/90 or ambulatory ≥130/80), often with specific requirements for current medication. Some trials target uncontrolled BP despite treatment
RDN trials — typically require resistant or uncontrolled hypertension despite medication, suitable renal anatomy (renal arteries ≥3mm diameter, no significant stenosis), and exclusion of secondary causes
Device trials — often require severe or resistant hypertension with documented failure of multiple medications. Cardiovascular and anatomical screening required
Digital health trials — usually the broadest inclusion criteria; many accept treated or untreated hypertension with home monitoring capability
Exclusion criteria — secondary hypertension (unless specifically targeted), significant renal impairment (eGFR <30 for many trials), recent cardiovascular event, and pregnancy
💡 Tip: Bring Your Blood Pressure Readings
Trial teams will want to see your recent blood pressure readings — ideally home readings over 7 days (morning and evening) or a 24-hour ambulatory BP monitor result. They will also need a list of current medications and doses, any previous medications tried, kidney function tests (eGFR, creatinine), and electrolyte levels. Your GP practice can provide a summary printout or online record access.
UK Hypertension Trial Locations
Major UK centres running hypertension trials include:
London — Barts Health NHS Trust, Imperial College Healthcare, Guy's and St Thomas', Royal Brompton, Hammersmith Hospital
Glasgow — Queen Elizabeth University Hospital, University of Glasgow BHF Cardiovascular Research Centre
Birmingham — University Hospitals Birmingham, Queen Elizabeth Hospital Birmingham
Cambridge — Addenbrooke's Hospital, University of Cambridge
Leicester — University Hospitals of Leicester, Leicester Biomedical Research Centre
Edinburgh — Royal Infirmary of Edinburgh, University of Edinburgh
Sheffield — Northern General Hospital, University of Sheffield
Oxford — John Radcliffe Hospital, University of Oxford
How to Find Your Match
Use our Smart Matcher to find hypertension trials tailored to your blood pressure levels, current medications, kidney function, and treatment goals. Whether you are exploring renal denervation for resistant hypertension, interested in novel medications, or want to try a digital monitoring approach, we can match you to actively recruiting studies.