Renal Denervation for Treating Hypertension: Current Scientific and Clinical Evidence

Weber MA, Mahfoud F, Schmieder R, Kandzari DE, Tsioufis KP, Townsend RR, Kario K, Böhm M, Sharp AS, Davies JE, Osborn JW, Fink GD, Euler DE, Cohen DL, Schlaich MP, Esler MD (2019)

Publication Type: Journal article, Review article

Publication year: 2019

Journal

Jacc-Cardiovascular Interventions Elsevier

Book Volume: 12

Pages Range: 1095-1105

Journal Issue: 12

DOI: 10.1016/j.jcin.2019.02.050

Abstract

Initial studies of catheter-based renal denervation (RDN) for uncontrolled HTN using radiofrequency ablation in the main renal arteries showed that RDN was effective in lowering office blood pressure (BP). However, the first randomized sham-controlled trial, SYMPLICITY-HTN-3, did not show significantly lower office or 24-h ambulatory systolic BP compared with sham treatment. Subsequent studies in both animals and humans demonstrated the potential importance of more distal and branch renal artery radiofrequency ablation, and a second-generation multielectrode system became available. Two recent randomized sham-controlled trials in patients not taking antihypertensive drugs (SPYRAL HTN-OFF MED) or continuing to take drugs (SPYRAL HTN-ON MED) performed RDN with the second-generation radiofrequency ablation system using an ablation protocol that included treatment of the distal renal artery as well as the branch renal arteries. These studies showed that RDN significantly reduced office and 24-h ambulatory BP compared with sham treatment. Another recent randomized sham-controlled trial in patients not receiving medications showed that RDN with catheter-based ultrasound (RADIANCE-HTN SOLO) applied in just the main renal arteries significantly lowered daytime ambulatory and office BP compared with sham treatment. These trials have renewed clinical and scientific interest in defining the appropriate role of RDN in hypertension treatment. In addition, other important issues will need to be addressed in the future such as the development of tests to determine the extent of RDN at the time of the procedure and the potential of renal nerve fibers to regain their patency at some later stage following the ablation procedure.

Authors with CRIS profile

Roland Schmieder Professur für Innere Medizin (Nephrologie)

Involved external institutions

SUNY Downstate Medical Center US United States (USA) (US) Universitätsklinikum des Saarlandes (UKS) DE Germany (DE) Piedmont Healthcare US United States (USA) (US) National and Kapodistrian University of Athens GR Greece (GR) University of Pennsylvania US United States (USA) (US) Jichi Medical University / 自治医科大学 JP Japan (JP) Royal Devon & Exeter NHS Foundation Trust GB United Kingdom (GB) Imperial College London / The Imperial College of Science, Technology and Medicine GB United Kingdom (GB) University of Minnesota (UMN) US United States (USA) (US) Michigan State University US United States (USA) (US) Medtronic US United States (USA) (US) Baker Idi Heart And Diabetes Institute AU Australia (AU)

How to cite

APA:

Weber, M.A., Mahfoud, F., Schmieder, R., Kandzari, D.E., Tsioufis, K.P., Townsend, R.R.,... Esler, M.D. (2019). Renal Denervation for Treating Hypertension: Current Scientific and Clinical Evidence. Jacc-Cardiovascular Interventions, 12(12), 1095-1105. https://doi.org/10.1016/j.jcin.2019.02.050

MLA:

Weber, Michael A., et al. "Renal Denervation for Treating Hypertension: Current Scientific and Clinical Evidence." Jacc-Cardiovascular Interventions 12.12 (2019): 1095-1105.

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