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Renale Denervation

Wirklich eine Alternative zu Blutdrucksenkern?

Renal denervation

Really an alternative to reducing blood pressure?

  • Arzneimitteltherapie
  • Published:
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Zusammenfassung

Seit der Veröffentlichung der aktuellen Leitlinien im Jahr 2018 wurden insgesamt 5 Sham-kontrollierte Studien mit hoher Qualität zur renalen Denervation durchgeführt und die Ergebnisse veröffentlicht. Diese 5 Studien belegen die Wirksamkeit und Sicherheit der renalen Denervation, die den Kenntnissen der Clinical Consensus Conference entsprechen, eindeutig. Somit ist eine Anpassung des Stellenwerts der renalen Denervation in der leitliniengerechten Blutdrucktherapie dringend erforderlich. Aus diesem Grund wurde das Positionspapier der Arbeitsgruppe der europäischen Bluthochdruckliga zum aktuellen Stand der renalen Denervation erarbeitet. Es kann mit einer zeitnahen Zulassung dieses Verfahrens gerechnet werden. In Deutschland gibt es eine DRG für die renale Denervation, die wegen der fehlerhaften Symplicity-3-Studie ausgesetzt wurde. Durch einen strukturierten Prozess der Einführung der renalen Denervation in die Praxis soll diese DRG wiederbelebt werden. Es wird dann gemeinsame Aufgabe der behandelnden Ärzte und der zertifizierten Zentren sein, hierfür geeignete Patienten zu identifizieren. Die Bluthochdrucktherapie wird auch in Zukunft aus den 3 Säulen Lifestyle-Maßnahmen, medikamentöse Therapie und interventionelle Therapie bestehen. Dies sollte nicht kompetitiv (Was ist besser?), sondern alternativ (Patientenpräferenz) und additiv (Blutdruckkontrolle ist das Ziel) betrachtet werden. Es ist Aufgabe der behandelten Ärzte, dem Patienten das ideale Therapiekonzept anzubieten. Die renale Denervation wird die medikamentöse Therapie dabei nicht ersetzen können, aber zur Reduktion der Medikamentenlast führen und die Adhärenz der Patienten erhöhen. Sie wird in der modernen Bluthochdrucktherapie auch bei speziellen Patientengruppen zunehmend an Bedeutung gewinnen.

Abstract

Since the current guidelines were published in 2018, a total of 5 sham-controlled high-quality studies evaluating renal denervation have been conducted and the results were published. These five studies clearly confirmed the efficacy and safety of renal denervation, which correspond to the knowledge of the Clinical Consensus Conference. Thus, an update of the guidelines for the treatment of arterial hypertension regarding the clinical significance of renal denervation is urgently necessary. For this reason, the position paper of the working group of the European Society of Hypertension on the current state of renal denervation was reviewed. An approval of this procedure can soon be expected. In Germany there is a diagnosis-related group (DRG) for the reimbursement of renal denervation, which was suspended due to the erroneous Symplicity 3 study. This DRG should be revived in practice by a structured process of the implementation of renal denervation. It will then be a joint task of treating physicians and specialists in certified centers to identify eligible patients. In the future, antihypertensive treatment will consist of three pillars: lifestyle measures, pharmacotherapy and interventional treatment. These three treatment options should not be regarded as competitive (which is better) but alternative (patient preference) and additive (the aim is blood pressure control). It is the task of the treating physician to provide the patient with the ideal treatment concept. Clearly, renal denervation will not replace antihypertensive pharmacotherapy; however, it can lead to a reduction of the drug burden and increase of patient adherence to medication. It represents an option of modern antihypertensive treatment and will also become increasingly more important in special patient groups.

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  1. Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland

    Kristina Striepe,  Mario Schiffer &  Roland Schmieder

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  1. Kristina Striepe
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Correspondence to Roland Schmieder.

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Interessenkonflikt

R. Schmieder gibt an, Vertrags‑/Beraterhonorar erhalten zu haben von: Ablative Solutions, Medtronic and Recor. Zudem wurde Forschungsunterstützung von Ablative Solution, Medtronic and Recor an die Universitätsklinik Erlangen geleistet. K. Striepe und M. Schiffer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Striepe, K., Schiffer, M. & Schmieder, R. Renale Denervation. Internist 63, 330–340 (2022). https://doi.org/10.1007/s00108-021-01242-3

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