Renal Denervation in Human Hypertension: Mechanisms, Current Findings, and Future Prospects
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Denervating the human kidney to improve blood pressure control is an old therapeutic concept first applied on a larger scale by surgeons in the 1920s. With the advent of modern pharmacology and the development of powerful drugs to lower blood pressure, approaches to directly target the sympathetic nerves were more or less abandoned. Over the past 2–3 years, however, we have witnessed enormous renewed interest in novel and minimally invasive device-based approaches to specifically target the renal nerves. The enthusiasm is fueled by promising results from proof-of-concept studies and clinical trials demonstrating convincing blood pressure–lowering effects in the majority of treated patients, and perhaps even more so by observations indicating potential additional benefits relating to common comorbidities of hypertension, such as impaired glucose metabolism, renal impairment, left ventricular hypertrophy, and others. Herein we review the current findings and assess whether these high hopes are justified.
KeywordsRenal denervation Sympathetic Activation Hypertension Blood pressure Cardiovascular Renal nerve ablation Glucose metabolism Renal disease Renal failure Left ventricular hypertrophy
Parts of this work were funded by grants from the National Health and Research Council of Australia (NHMRC) and the Victorian Government’s Operational Infrastructure Support Program.
Dr. Schlaich has served on a board for, served as a consultant for, served on the speaker’s bureau for, received grant support from, and received travel support from Ardian/Medtronic.
Dr. Schlaich and Dr. Esler are supported by career fellowships from the NHMRC.
Dr. Hering is currently supported by Research Fellowship from the Foundation for Polish Science KOLUMB/2010-1.
Dr. Schlaich, Dr. Krum, and Dr. Esler are investigators in ClinicalTrials.gov: NCT00483808 and ClinicalTrials.gov: NCT 00551304, sponsored by Ardian/Medtronic.
Dr. Sobotka is an employee of Ardian/Medtronic.
Dr. Krum has served on the speaker’s bureau for Ardian/Medtronic.
Dr. Esler has had travel expenses/accommodations covered/reimbursed by, has served as a consultant for, has received grant support from, and has served on the speakers’ bureau/developed educational presentations for Ardian/Medtronic.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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