Percutaneous renal sympathetic denervation: 2013 and beyond

Area of Science:

• Cardiology
• Nephrology
• Interventional Radiology

Background:

• Systemic hypertension impacts nearly 25% of Canadian adults.
• Resistant hypertension, where blood pressure targets are unmet despite interventions, affects a significant population.
• Renal sympathetic overactivity is a key factor in hypertension pathophysiology.

Purpose of the Study:

• To evaluate the efficacy and safety of percutaneous renal sympathetic denervation for resistant hypertension.
• To explore the potential of renal denervation in managing other conditions linked to sympathetic overactivity.
• To review the current evidence and future directions for renal denervation therapy.

Main Methods:

• Initial studies involved case reports and small trials, including the randomized Symplicity HTN-2 trial.
• The Symplicity HTN-3 trial randomized 530 patients to renal denervation versus a sham procedure.
• Future trials will assess clinical endpoints and utilize 24-hour ambulatory blood pressure monitoring.

Main Results:

• The Symplicity HTN-2 trial showed a significant mean blood pressure reduction (32/12 mm Hg) at 6 months post-renal denervation.
• Limitations of current evidence include small study sizes and incomplete follow-up.
• Ongoing and future trials aim to provide more robust data on efficacy and safety.

Conclusions:

• Percutaneous renal sympathetic denervation shows promise for treating resistant hypertension.
• Further high-quality evidence from larger trials is essential to establish its role in clinical practice.
• Exploration of new devices and indications, alongside careful patient selection, will shape the future of this therapy.