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Renal Denervation Update From the International Sympathetic Nervous System Summit: JACC State-of-the-Art Review
Institution:1. Dobney Hypertension Centre, School of Medicine–Royal Perth Hospital Unit, University of Western Australia and Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia;2. Neurovascular Hypertension & Kidney Disease Laboratory and Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia;3. Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan;4. Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota;5. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany;6. Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia;7. Department of Internal Medicine and Molecular Physiology and Biophysics, University of Iowa, Carver College of Medicine, Iowa City, Iowa;8. The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana;9. Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy;10. Prairie Heart Institute at St. John''s Hospital, Department of Cardiology, Springfield, Illinois;11. Department of Pharmacology and Physiology, St. Louis University School of Medicine, St. Louis, Missouri;12. Departments of Internal Medicine and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, Iowa;13. Cardiovascular Center of Excellence and Department of Pharmacology, LSU Health Science Center, New Orleans, Louisiana;14. Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Missouri;15. The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia;p. Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand;q. School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom;r. Department of Nephrology and Hypertension, University Hospital of the University Erlangen-Nuremberg, Erlangen, Germany;s. Departments of Anesthesiology and Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska;t. Chaim Sheba Medical Center and Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Abstract:Three recent renal denervation studies in both drug-naïve and drug-treated hypertensive patients demonstrated a significant reduction of ambulatory blood pressure compared with respective sham control groups. Improved trial design, selection of relevant patient cohorts, and optimized interventional procedures have likely contributed to these positive findings. However, substantial variability in the blood pressure response to renal denervation can still be observed and remains a challenging and important problem. The International Sympathetic Nervous System Summit was convened to bring together experts in both experimental and clinical medicine to discuss the current evidence base, novel developments in our understanding of neural interplay, procedural aspects, monitoring of technical success, and others. Identification of relevant trends in the field and initiation of tailored and combined experimental and clinical research efforts will help to address remaining questions and provide much-needed evidence to guide clinical use of renal denervation for hypertension treatment and other potential indications.
Keywords:blood pressure  cardiovascular disease  hypertension  renal denervation  sympathetic nervous system  DOCA"}  {"#name":"keyword"  "$":{"id":"kwrd0040"}  "$$":[{"#name":"text"  "_":"deoxycorticosterone acetate  DS"}  {"#name":"keyword"  "$":{"id":"kwrd0050"}  "$$":[{"#name":"text"  "_":"Dahl salt-sensitive  RDN"}  {"#name":"keyword"  "$":{"id":"kwrd0060"}  "$$":[{"#name":"text"  "_":"renal denervation  RSNA"}  {"#name":"keyword"  "$":{"id":"kwrd0070"}  "$$":[{"#name":"text"  "_":"renal sympathetic nerve activity  RVLM"}  {"#name":"keyword"  "$":{"id":"kwrd0080"}  "$$":[{"#name":"text"  "_":"rostral ventrolateral medulla
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