Renal sympathetic denervation for resistant hypertension: where do we stand after more than a decade

Abstract

Despite the current availability of safe and efficient drugs for treating hypertension, a substantial number of patients are drug-resistant hypertensives. Aiming this condition, a relatively new approach named catheter-based renal denervation was developed. We have now a clinically relevant time window to review the efficacy of renal denervation for treating this form of hypertension. This short review addresses the physiological contribution of renal sympathetic nerves for blood pressure control and discusses the pros and cons of renal denervation procedure for the treatment of resistant hypertension.

Renal Denervation – a Modern Option for Treating Resistant Hypertension

“…Sympathetic activation triggers renal arterial vasoconstriction, which leads to the stimulation of renin secretion with increased sodium and water reabsorption and increased blood pressure. 2,5 This overexpressed sympathetic activation is more pronounced in the younger population. 8 Current guideline recommendations regarding the use of renal denervation/ablation as a therapeutic strategy are controversial.…”

“…However, due to its invasive nature, this therapeutic method is not routinely recommended. 1,2 An important role in the etiology of hypertension is played by the genetic factor interconnected with environmental, behavioral, and social factors. Globally, more than 1 billion people are suffering from hypertension, which contributes to 218 million disability-adjusted life years.…”

“…However, the results vary widely, from a significant reduction of ambulatory systolic blood pressure to an insignificant effect on blood pressure reduction. 2 These differences can be explained by incorrect blood pressure measurement techniques, the different classes and doses of the drugs used to treat hypertension, and the different response of each patient to drug therapy. 1,2 The most important clinical trials that have studied the efficacy of renal ablation are SYMPLICITY HTN-2, HIT-ON MED, SPYRAL HTN-OFF MED, and RADIANCE-HTN SOLO.…”

“…2 These differences can be explained by incorrect blood pressure measurement techniques, the different classes and doses of the drugs used to treat hypertension, and the different response of each patient to drug therapy. 1,2 The most important clinical trials that have studied the efficacy of renal ablation are SYMPLICITY HTN-2, HIT-ON MED, SPYRAL HTN-OFF MED, and RADIANCE-HTN SOLO. 1,2 Results from the SYMPLICITY HTN-2 study, performed on a sample of 106 patients, have shown a reduction in blood pressure of 31/12 mmHg in patients with renal denervation, compared with 0/-1 mmHg in patients using only drug therapy.…”

“…1,2 The most important clinical trials that have studied the efficacy of renal ablation are SYMPLICITY HTN-2, HIT-ON MED, SPYRAL HTN-OFF MED, and RADIANCE-HTN SOLO. 1,2 Results from the SYMPLICITY HTN-2 study, performed on a sample of 106 patients, have shown a reduction in blood pressure of 31/12 mmHg in patients with renal denervation, compared with 0/-1 mmHg in patients using only drug therapy. 5 SYMPLICITY HTN-3 (2014), the first renal denervation trial, did not reveal significant differences between the invasively treated group (renal ablation procedure) and the control one.…”