Current Cardiology Reports

, 13:478 | Cite as

Can Catheter-Based Renal Denervation Be Used Safely and Effectively to Substantially Reduce Blood Pressure in Treatment-Resistant Hypertensive Patients?

  • Suzanne OparilEmail author
Clinical Trial Report

Trial: Esler MD, Krum H, Sobotka PA, et al.: Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010, 376:1903–1909.

Rating: Of significant importance.

Introduction:Successful treatment of elevated blood pressure (BP) has proven elusive despite availability of various drugs, combination pharmaceutical products, and resources to assist patients’ adherence and lifestyle changes. The failure of present strategies suggests underlying pathophysiology that is refractory to available interventions. Renal sympathetic nerves contribute to development and perpetuation of hypertension, and sympathetic outflow to the kidneys is activated in patients with essential hypertension. Efferent sympathetic outflow stimulates renin release, increases tubular sodium reabsorption, and reduces renal blood flow. Afferent signals from the kidney modulate central sympathetic outflow and thereby directly contribute...


Renal denervation Resistant hypertension Sympathectomy Blood pressure 


  1. 1.
    Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: Diagnosis, evaluation, and treatment. A Scientific Statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403–19.PubMedCrossRefGoogle Scholar
  2. 2.
    Nishizaka MK, Zaman MA, Calhoun DA. Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am J Hypertens. 2003;16:925–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Pimenta E, Gaddam KK, Husain S, et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: results from a randomized trial. Hypertension. 2009;54:475–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Winternitz SR, Katholi RE, Oparil S. Role of the renal sympathetic nerves in the development and maintenance of hypertension in the spontaneously hypertensive rat. J Clin Invest. 1980;66:971–8.PubMedCrossRefGoogle Scholar
  5. 5.
    DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev. 1997;77:75–197.PubMedGoogle Scholar
  6. 6.
    Schlaich M, Sobotka P, Krum H, et al. Renal denervation as a therapeutic approach for hypertension: Novel implications for an old concept. Hypertension. 2009;54:1195–201.PubMedCrossRefGoogle Scholar
  7. 7.
    Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373:1275–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361:932–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Doumas M, Douma S. Renal sympathetic denervation: the jury is still out. Lancet. 2010;376:1878–80.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA

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