Novel Approaches for the Treatment of the Patient with Resistant Hypertension: Renal Nerve Ablation
- 177 Downloads
Sympathetic innervation of the kidneys plays a major role in the pathogenesis of hypertension through modulation of renin secretion, glomerular filtration rate and renal absorption of sodium. Targeted interventions for renal nerve ablation are being developed for treatment of drug-resistant hypertension in the USA and the rest of the world. Early studies with the use of radiofrequency-based renal denervation systems have shown encouraging results with significant reduction of blood pressure in patients inadequately controlled despite nearly maximal drug therapy regimens. Thus far, the renal denervation procedure has been associated with minimal side effects. Long-term efficacy and safety beyond 3 years needs to be determined for renal nerve ablation. This review focuses on the physiology of the renal sympathetic system, the rationale for renal nerve ablation and current evidence in support of the available therapeutic renal denervation systems.
KeywordsResistant hypertension Renal denervation Renal nerve ablation Sympathetic nervous system
Compliance with Ethics Guidelines
Conflict of Interest
Vinay Gulati declares that he has no conflict of interest.
William B. White is a steering committee member for St. Jude Medical.
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.World Health Organization. World Health Report 2002: reducing risks, promoting healthy life. Geneva: World Health Organization; 2002.Google Scholar
- 25.•• Mahfoud F, Lüscher TF, Andersson B. Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. Eur Heart J. 2013;34:2149–57. This expert consensus document summarizes the view of an expert panel of the European Society of Cardiology and the European Association of Percutaneous Cardiovascular Interventions to provide guidance regarding renal denervation.PubMedCrossRefGoogle Scholar
- 27.The Symplicity HTN-1 Investigators. Three-year follow-up of Symplicity HTN-1 trial. Abstract presented at the 61st Annual Scientific Sessions of the American College of Cardiology. Chicago, IL; 25 March 2012.Google Scholar
- 28.• Esler MD, Krum H, Sobotka PA, et al. Symplicity HTN-2 investigators. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376:1903–9. The first randomized efficacy study providing evidence of therapeutic benefit of renal sympathetic denervation in patients with resistant hypertension.PubMedCrossRefGoogle Scholar
- 29.O’Riordan M. BP reductions with renal denervation durable to 30 months: Symplicity HTN-2. theheart.org. [Clinical Conditions > Interventional/Surgery > Interventional/Surgery]. http://www.theheart.org/article/1541263.do. Accessed 28 May 2013.
- 30.• Kandzari DE, Bhatt DL, Sobotka PA, et al. Catheter-based renal denervation for resistant hypertension: rationale and design of the Symplicity HTN-3 trial. Clin Cardiol. 2012;35(9):528–35. The first randomized, placebo-controlled trial to study the long-term efficacy of renal nerve ablation in patients with resistant hypertension.PubMedCrossRefGoogle Scholar
- 31.Worthley S. Safety and efficacy of a novel quadrapolar renal denervation catheter in patients with resistant hypertension: a first-in-man multicenter study. Abstract presented at the 2012 Annual Scientific Sessions of the European Association for Percutaneous Cardiovascular Interventions. Paris, France; 16 May 2012.Google Scholar
- 32.Hoppe U. Clinical experience with Vessix Vascular balloon renal denervation catheter. Abstract presented at the 2012 Annual Scientific Sessions of the European Association for Percutaneous Cardiovascular Interventions. Paris, France; 17 May 2012.Google Scholar
- 35.Bonan R. PARADISE: first-in-man results of a novel circumferential catheter-based ultrasound technology for renal denervation. Abstract presented at the 2012 Annual Scientific Sessions of the European Association for Percutaneous Cardiovascular Interventions. Paris, France; 16 May 2012.Google Scholar
- 39.Wood S. EnligHTN-1: BP drops durable, safe at one year, as renal-denervation mania grows. theheart.org. [Clinical Conditions > Hypertension > Hypertension]. http://www.theheart.org/article/1543267.do. Accessed 28 May 2013.
- 41.Mahfoud F, Lenski M, Ukena C, et al. Influence of renal sympathetic denervation on orthostatic function in patients with resistant hypertension. Circulation. 2012;126, A17201.Google Scholar
- 46.Pokushalov E, Romanov A, Corbucci G, et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol. 2012;60:1163–70.PubMedCrossRefGoogle Scholar
- 51.• Geisler BP, Egan BM, Cohen JT, et al. Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension. J Am Coll Cardiol. 2012;60:1271–7. The only cost-effectiveness evaluation for renal denervation in resistant hypertension management.PubMedCrossRefGoogle Scholar