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Renal Denervation in the Treatment of Hypertension

  • Secondary Hypertension: Adrenal and Nervous System Mechanisms (S Oparil, Section Editor)
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Abstract

Despite advances in nonpharmacologic and pharmacologic therapy, blood pressure control rates in hypertension are low. About 10 % of patients with hypertension fulfill the criteria of therapy resistance, which is defined as noncontrolled blood pressure despite treatment with ≥3 antihypertensive drugs of different classes, including a diuretic, at optimal or maximal tolerated doses. Although the pathogenesis of resistant hypertension is multifactorial, an interaction between renal afferent and efferent sympathetic nerves and the central nervous system plays a key role, leading to increased renal and central sympathetic activity. Catheter-based renal sympathetic denervation (RDN) is a novel therapeutic technique for the treatment of resistant hypertension. Clinical trials of RDN have shown a significant and sustained reduction of blood pressure as well as renal and central sympathetic activity. In clinical practice, appropriate patient selection is crucial to ensure successful and safe treatment. Beyond hypertension, RDN was associated with reduction of heart rate, regression of left ventricular mass, and improvements in glucose metabolism and severity of sleep apnea. Further studies addressing open questions in the treatment of resistant hypertension and evaluating potential new indications such as metabolic syndrome or heart failure (RE-ADAPT-HF) are necessary to prove effectiveness and safety of RDN in these patients. By modulating sympathetic activity, RDN has the potential to provide benefit in a variety of diseases, but these concepts have to be evaluated in well-designed prospective controlled clinical trials.

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Acknowledgments

Christian Ukena, Felix Mahfoud, and Michael Böhm are supported by the Ministry of Science and Economy of the Saarland. All authors are supported by the Deutsche Forschungsgemeinschaft (KFO 196). Felix Mahfoud and Sebastian Ewen are supported by Deutsche Hochdruckliga und Deutsche Gesellschaft für Kardiologie.

Conflict of Interest

Christian Ukena, Felix Mahfoud, and Michael Böhm have received speaker honoraria from Medtronic/Ardian, St. Jude Medical, and/or Cordis.

Ulrich Laufs and Bodo Cremers have received speaker honorarium from Medtronic.

Sebastian Ewen declares that he has no conflict of interest.

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  1. Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66421, Homburg, Saar, Germany

    Christian Ukena, Felix Mahfoud, Sebastian Ewen, Bodo Cremers, Ulrich Laufs & Michael Böhm

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  1. Christian Ukena
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  2. Felix Mahfoud
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Correspondence to Christian Ukena.

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Ukena, C., Mahfoud, F., Ewen, S. et al. Renal Denervation in the Treatment of Hypertension. Curr Hypertens Rep 15, 363–369 (2013). https://doi.org/10.1007/s11906-013-0363-2

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