One swallow does not a summer make: safety and renal denervation

Renal denervation is increasingly being adopted as a treatment option in patients with resistant hypertension. The long-term safety of this procedure is unknown. Though the procedure interrupts the sympathetic nerves at the renal level, it also has effects on other organ beds, notably the heart and vasculature. These effects have been purported to be clinically beneficial and thus formed a rationale for examining the role of renal denervation in other conditions, including heart failure, arrhythmia, obstructive sleep apnoea and the metabolic syndrome. There is a theoretical concern that attenuating the renal sympathetic nerves might cause orthostatic hypotension or syncope. From the limited data available from hypertension trials, the procedure has not been associated with excessive episodes of syncope and this is supported by mechanistic tilt table data in asymptomatic patients. Ultimately, the safety of this technique will only be established once we have larger phase III/IV studies.