Despite industry-wide contraction last year after Medtronic's SYMPLICITY, some believe a hypertension device is just around the corner. With a market estimated in the billions or even tens of billions of dollars, both Medtronic and Boston Scientific are launching redesigned studies, and a determined handful of medtech start-ups continue to pursue a device-based solution for treating hypertension with invasive and noninvasive approaches, including renal sympathetic denervation through radiofrequency, ultrasound, or drugs; neuromodulation in the forearm; and cold therapy to specialized cells in the neck.

Despite industry-wide contraction last year after Medtronic's SYMPLICITY, many agree the trial was flawed, and some believe a hypertension device is just around the corner. A determined handful of medtech start-ups continue to pursue a device-based approach, most by reducing “fight-or-flight” outflow from the sympathetic nervous system.

Manufacturers are finding it harder to innovate in the vascular interventional devices as market and regulatory pressures take their toll. New coronary drug-eluting stents face a difficult challenge with the high bar now set by existing devices, and there have been several recent disappointments in renal denervation, drug-coated balloons, and renal artery stenting; still there are some promising areas, with bioresorbable stents offering perhaps the best prospect among vascular therapies for future blockbuster status.