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The Future of Renal Denervation in Resistant Hypertension

  • Secondary Hypertension: Nervous System Mechanisms (J Bisognano, Section Editor)
  • Published:
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Abstract

Resistant hypertension, defined as inadequate blood pressure control despite three or more antihypertensive medications at maximally tolerated doses, is strongly linked to increased cardiovascular morbidity and mortality. Increased renal afferent and efferent sympathetic activity carried by nerves which arborize the adventitia of the renal arteries, appears to be central to the pathobiology of resistant hypertension. Historical experience indicates that surgical denervation and/or sympathectomy often dramatically reduced blood pressure in patients with malignant hypertension. Catheter-based radio-frequency renal denervation was developed in the past decade as a percutaneous adaptation of surgical denervation. Percutaneous renal denervation using a variety of systems has demonstrated to date, in non-randomized and unblinded studies, dramatic reductions in office-based blood pressure, but more modest impact on ambulatory blood pressure. The only single, appropriately powered, blinded, sham-controlled study of renal denervation conducted to date, however, failed to meet its primary endpoint, casting doubt on the value of the therapy. Ancillary benefits of renal denervation have been described in such conditions as diabetes mellitus, heart failure, and sleep apnea but require further study. While renal denervation is already widely available outside of the USA for commercial use, its utility in resistant hypertension must be vetted by further rigorous investigation before its use can be routinely recommended.

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Conflict of Interest

Sandeep Nathan reports consulting/speaking fees from Medtronic, during the conduct of the study; consulting fees from Maquet; consulting fees from Abiomed; consulting/speaking fees from Astra Zeneca; and grants from Accumetrics, outside the submitted work. George L. Bakris declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Medicine, Section of Cardiology and ASH Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 1027, Chicago, IL, 60637, USA

    Sandeep Nathan & George L. Bakris

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  1. Sandeep Nathan
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  2. George L. Bakris
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Correspondence to George L. Bakris.

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This article is part of the Topical Collection on Secondary Hypertension: Nervous System Mechanisms

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Nathan, S., Bakris, G.L. The Future of Renal Denervation in Resistant Hypertension. Curr Hypertens Rep 16, 494 (2014). https://doi.org/10.1007/s11906-014-0494-0

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  • DOI: https://doi.org/10.1007/s11906-014-0494-0

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