Renal Denervation for Treating Hypertension: Current Scientific and Clinical Evidence |
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Affiliation: | 1. Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York;2. Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Homburg, Germany;3. Department of Nephrology and Hypertension, University Hospital of the Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany;4. Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia;5. Department of Cardiology, National and Kapodistrian University of Athens, Hippocration Hospital, Athens Medical Center, Athens, Greece;6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;7. Department of Cardiovascular Medicine and Department of Sleep and Circadian Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan;8. Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, United Kingdom;9. International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom;10. Department of Physiology, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota;11. Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan;12. Medtronic, Minneapolis, Minnesota;13. Baker IDI Heart and Diabetes Institute, Melbourne, Australia;14. Dobney Hypertension Centre, Royal Perth Hospital Campus–University of Western Australia, Perth, Australia |
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Abstract: | Initial studies of catheter-based renal denervation (RDN) for uncontrolled HTN using radiofrequency ablation in the main renal arteries showed that RDN was effective in lowering office blood pressure (BP). However, the first randomized sham-controlled trial, SYMPLICITY-HTN-3, did not show significantly lower office or 24-h ambulatory systolic BP compared with sham treatment. Subsequent studies in both animals and humans demonstrated the potential importance of more distal and branch renal artery radiofrequency ablation, and a second-generation multielectrode system became available. Two recent randomized sham-controlled trials in patients not taking antihypertensive drugs (SPYRAL HTN-OFF MED) or continuing to take drugs (SPYRAL HTN-ON MED) performed RDN with the second-generation radiofrequency ablation system using an ablation protocol that included treatment of the distal renal artery as well as the branch renal arteries. These studies showed that RDN significantly reduced office and 24-h ambulatory BP compared with sham treatment. Another recent randomized sham-controlled trial in patients not receiving medications showed that RDN with catheter-based ultrasound (RADIANCE-HTN SOLO) applied in just the main renal arteries significantly lowered daytime ambulatory and office BP compared with sham treatment. These trials have renewed clinical and scientific interest in defining the appropriate role of RDN in hypertension treatment. In addition, other important issues will need to be addressed in the future such as the development of tests to determine the extent of RDN at the time of the procedure and the potential of renal nerve fibers to regain their patency at some later stage following the ablation procedure. |
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Keywords: | ambulatory blood pressure hypertension radiofrequency renal denervation ultrasound BP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" blood pressure DBP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" diastolic blood pressure eGFR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" estimated glomerular filtration rate HTN" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" hypertension NE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" norepinephrine RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" randomized controlled trial RDN" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" renal denervation RF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" radiofrequency RNS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" renal nerve stimulation SBP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" systolic blood pressure |
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