Renale Denervierung und Hypertonie

Catheter-based renal nerve ablation can lower blood pressure (BP) in hypertensive patients. The concept is based on solid physiological studies suggesting that efferent and afferent renal nerves contribute to arterial hypertension. The preliminary results on the efficacy and safety of catheter-based renal nerve ablation on BP control in resistant hypertension have been encouraging; however, these studies were uncontrolled. In several small studies it was observed early that most patients can be controlled by pharmaceutical treatment and only a few patients respond to ablation therapy. A large prospective trial with a control group (sham treatment) was therefore necessary. The Simplicity-3 trial fulfilled these criteria. More than 600 patients were successfully studied and in March 2014 the results were published. No significant differences between the two groups were observed, one treated with renal nerve ablation and the other group controlled only by medication. These results are in contrast to the previous (uncontrolled) studies and observations from a worldwide registry. Several explanations have been put forward to explain these results. Important are (1) compliance, i.e. patients taking their medication during the study and also (2) inexperience with the method in small centers. Simplicity-3 has put a halt on using renal denervation in most countries. It is now important to find out why the method only works in some patients, what the criteria to use it are and to define a patient group where renal denervation is useful as a therapeutic method to treat patients with hypertension.