Renal denervation: recent developments in clinical and preclinical research

Abstract

Purpose of review Renal denervation represents a new dimension to hypertension treatment, with multiple device manufacturers seeking premarket FDA approval currently. Interest in the efficacy and safety of the treatment has spurred compelling mechanistic studies into the function of renal nerves and downstream impacts of denervation. Recent findings A trial of the ultrasound Paradise Catheter system (RADIANCE II) found a 6.3 mmHg reduction in SBP relative to sham controls. A trial of the Symplicity Spyral system (SPYRAL HTN-ON MED) found an insignificant reduction in SBP relative to sham controls. Individuals were taking antihypertensive medications during the study, and investigators note the sham group experienced a larger medication burden than the denervated group. Recent preclinical studies have evaluated potential risks of renal denervation, how sympathetic activity broadly is affected, as well as identifying possible biomarkers to identify individuals where denervation would be more successful. Summary Studies of renal denervation continue to find a robust antihypertensive effect, especially in studies wherein medications are withdrawn. Further investigation into mechanisms and indicators for usage of the technique will be important in identifying the patient population most likely to benefit from usage of renal denervation.

IL-1R Mediated Activation of Renal Sensory Nerves in DOCA-Salt Hypertension

“…1 Finally, the role of the sympathetic nervous system in hypertension is clinically supported by trials of catheter-based renal nerve ablation (CBRNA), which have demonstrated sustained reductions in arterial pressure in patients with drugresistant hypertension. 3 Along with decreased arterial pressure, CBRNA has also been reported to reduce skeletal muscle SNA, 4 episodes of sleep apnea, 5 and cardiac arrhythmias. 6 These findings led to the hypothesis that CBRNA may decrease arterial pressure by ablating sympathoexcitatory afferent renal nerves (ARNs) rather than, or in addition to, efferent renal nerves.…”