Renal denervation as a management strategy for hypertension: current evidence and recommendations

ABSTRACT

Introduction

The concept of targeting the renal sympathetic nerves therapeutically to lower blood pressure (BP) is based on their crucial role in regulating both renal and cardiovascular control. These effects are mainly mediated via three major mechanisms including alteration of renal blood flow, renin-release, and Na⁺ retention. Initial surgical approaches applying crude and unselected sympathectomy, while rendering significant BP lowering and cardiovascular event reducing properties, where plagued by side effects. More modern selective catheter-based denervation approaches selectively targeting the renal nerves have been shown to be safe and effective in reducing BP in various forms of hypertension and multiple comorbidities.

Areas covered

This article covers the background relevant for the concept of renal denervation (RDN), the evidence obtained from relevant randomized controlled trials to substantiate the safety and efficacy of RDN, and recently published clinical recommendations.

Expert Opinion

Catheter-based RDN is safe and has now been shown in sham-controlled randomized clinical trials to result in clinically meaningful BP lowering in both drug naïve hypertensive patients and those on concomitant antihypertensive therapy. Real world data from a large global registry further supports the clinical utility of RDN. It now seems time to embed renal denervation into routine clinical care.

KEYWORDS:

• Chronic Kidney Disease
• Denervation
• Hypertension
• Interventional Approaches
• Radiofrequency Ablation
• Sympathetic Nervous System

Article highlights

• Catheter-based renal denervation is a safe interventional approach to therapeutically target the renal nerves

• Both radiofrequency- and ultrasound-based treatment strategies have been tested successfully in sham controlled randomized clinical trials

• Renal denervation is associated with significant and clinically relevant blood pressure lowering effects

• Blood pressure lowering can be achieved in both drug naïve patients with hypertension and those on concomitant antihypertensive therapy

• High-risk patient groups with elevated blood pressure including those with resistant hypertension, isolated systolic hypertension, diabetes, atrial fibrillation, and chronic kidney disease seem to benefit equally from renal denervation.

Declaration of interest

MP Schlaich is supported by an NHMRC Research Fellowship and has received consulting fees, and/or travel and research support from Medtronic, Abbott, Novartis, Servier, Pfizer, and Boehringer-Ingelheim. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.