Renal denervation: a new treatment option in resistant arterial hypertension

Abstract

Hypertension is one of the most prevalent cardiovascular risk factors. Despite this high prevalence and a broad availability of effective pharmaceutical agents, a significant proportion of patients do not reach treatment goals. Partly this can be explained by secondary causes of hypertension or non-compliance of patients. Nevertheless, a subgroup of patients can be diagnosed with 'resistant hypertension'. Activation of the sympathetic nervous system is known to be an important factor in the development and progression of systemic hypertension. In this context, a percutaneous, catheter-based approach has been developed using radiofrequency energy to disrupt renal sympathetic nerves. The first studies have shown this technique to be safe, illustrated by a lack of vascular or renal injury. More importantly, catheter-based renal nerve ablation resulted in a significant reduction in blood pressure on top of traditional medical therapy. Additional to the encouraging effects shown on hypertension, a positive influence of this intervention in other conditions, characterised by sympathetic overactivation, may be expected. Though this technique seems promising, further studies are needed to address long-term safety and efficacy of renal denervation in hypertension and other disease states.Keywords Renal denervation . Sympathetic nervous system . Resistant hypertension . Sympathetic activity HypertensionHypertension is one of the most prevalent cardiovascular risk factors. Globally, 34 % of adults worldwide have hypertension and this number is rising.[1, 2] Despite a broad availability of effective pharmaceutical agents, only 32 % of treated men and 37 % of treated women achieve treatment goals.[3] This low success ratio can be caused by noncompliance of patients to medical therapy or secondary causes of hypertension (i.e., primary hyperaldosteronism). However, a subgroup of patients do fulfil the criteria of the phenomenon called 'resistant hypertension'. In 2008, the American Heart Association (AHA) defined resistant hypertension as a blood pressure (BP) that remains above treatment goals despite the concurrent use of medication from three different antihypertensive classes, including a diuretic, with all agents prescribed at doses that provide optimal benefit.[4] Data indicate that patients with resistant hypertension have an approximately threefold increased risk for adverse cardiovascular outcome compared with patients with well-controlled hypertension.[5] To address problems associated with a rising prevalence of (resistant) hypertension, the sympathetic nervous system (SNS) has gained renewed interest as a therapeutic target. The sympathetic nervous systemAlthough the exact pathogenesis of an elevated BP remains unclear, it has become clear that (over)activation of the SNS is an important factor in the development and progression of systemic hypertension.[6] The SNS is known to be responsible for the homeostasis mechanism of multiple organ systems. Anderson et al. measured noradrenalin spillover and muscle ...

Cortical lateralization and cardiac autonomic control. Insights from insular stroke and epilepsy

“…New integrative therapeutic strategies in neurocardiology can offer different perspectives for vagal nerve stimulation on renal denervation practice in neurologic patients [66][67][68][69][70]. Our data aims to strengthen the need of careful cardio-vascular monitoring of these fragile patients, by including in routine clinical protocols, autonomic activity markers as reliable predictors for potentially lifethreatening, but preventable events.…”

Neurocardiology: close interaction between heart and brain

“…In this respect, vagal stimulation, exercise training, electrical neurostimulation, music therapy, and -recently-renal denervation have become interesting options in the treatment of angina pectoris, heart failure, and hypertension [21][22][23][24][25][26]. Various patient groups (psychological distress, atrial fibrillation, heart failure, post-CABG) may benefit when the appropriate mechanisms of the interrelation between the nervous system, brain and heart become elucidated [27].…”

Renal denervation with standard radiofrequency ablation catheter is effective in 24-hour ambulatory blood pressure reduction – follow-up at 1/3/6/12 months

“…The effect of RDN between the office BP and the 24‑h ABP measurements differed across the known RDN studies, reviewed by Verloop et al. and Bunte [ 23 , 24 ]. One reason for this might be that the 24‑h ABP was not the primary study endpoint (HTN-1 and 2) [ 7 , 8 ] or the required level for study inclusion was rather low (systolic 24‑h ABP >135 mmHg in HTN-3 and Global SYMPLICITY Registry) [ 9 , 14 ].…”