Catheter-Based Renal Denervation for Hypertension
- 274 Downloads
Purpose of Review
This review was undertaken to update readers on the field of therapeutic renal denervation for hypertension during the 2016 through 2018 period.
After the failure of Symplicity HTN-3 to meet its top line objective, intense scrutiny revealed several possible concerns addressed by the newer investigations into the area of renal denervation. These included better device technology, more intense subject monitoring for off-protocol antihypertensive drug usage, and deeper penetration into the renal vasculature by the interventionist.
Whether untreated by medication for hypertension or on antihypertensive medication, renal denervation shows a clear, though moderate, blood pressure reduction. The failure of roughly one out of three patients with hypertension to respond to denervation procedures argues that there is room for improvement in choosing the optimal patient for this approach to hypertension management.
KeywordsRenal denervation Hypertension Radiofrequency ablation Ultrasound ablation Alcohol ablation
Compliance with Ethical Standards
Conflict of Interest
Dr. Townsend reports personal fees from Medtronic and Rox Medical, outside the submitted work. Dr. Sobotka is Executive Consultant to Rox Medical.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Krum H, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373(9671):1275–81. First human series of patients treated for drug resistant hypertension using radiofrequency renal ablation. CrossRefPubMedGoogle Scholar
- 3.Kandzari DE, et al. Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 trial. ClinCardiol. 2012;35(9):528–35.Google Scholar
- 6.Kandzari DE, et al. Predictors of blood pressure response in the SYMPLICITY HTN-3 trial. In: Eur.Heart J, vol. 36; 2014. p. 219–27.Google Scholar
- 7.Townsend RR, Mahfoud F, Kandzari DE, Kario K, Pocock S, Weber MA, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017;390(10108):2160–70.CrossRefPubMedGoogle Scholar
- 9.Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Davies J, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet. 2018;391(10137):2335–45.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Kandzari DE, Böhm M, Mahfoud F, Townsend RR, Weber MA, Pocock S, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018;391(10137):2346–55.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.•• Mahfoud F, et al. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the global SYMPLICITY registry. Eur Heart J. 2017;38(2):93–100. This registry will be an important source of long-term efficacy and saftery of renal denervation. PubMedGoogle Scholar
- 16.• Sata Y, et al. Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation. J Hypertens. 2018;36(6):1414–22. Given the difficulty predicting responses in RDN studies like this are going to become inreasingly important as subject selection is streamlined. CrossRefPubMedGoogle Scholar
- 30.•• Pappaccogli, M., et al., Effectiveness of renal denervation in resistant hypertension: a meta-analysis of 11 controlled studies. High Blood Press Cardiovasc Prev, 2018. https://doi.org/10.1007/s40292-018-0260-5. Accessed 11 May 2018. This analysis was published before more recent studies. It basically finds little benefit in RDN as done in the period up to about 2016 . CrossRefGoogle Scholar