Renal denervation therapy for resistant hypertension: a clinical update

Severe hypertension (systolic blood pressure (BP) ⩾160 mm Hg) resistant to treatment with multiple antihypertensive medications, poses a serious challenge to therapeutic treatment. Catheter-based renal denervation (RDN) is being increasingly proposed and researched as a safe and effective method of treating this condition. This article evaluates the existing evidence on the effects of RDN on BP reduction and other conditions with increased sympathetic tone. Findings indicate that RDN is a safe and effective treatment for severe hypertension. Moreover, the antihypertensive response to RDN is sustained for up to 3 years of follow-up. RDN decreases office BP more than ambulatory BP, which may be explained by the white-coat effect that causes an increase in office BP. Findings indicate that although reinnervation may occur following RDN, it does not appear to attenuate or reverse the BP response over 24-36 months. There is also evidence that patients with milder forms of hypertension may benefit from RDN. Furthermore, there is emerging evidence that RDN may have a role in the treatment of heart failure, obstructive sleep apnea, insulin resistance, atrial fibrillation and hypertension associated with end-stage renal disease. Taking into account that resistant hypertension and other diseases associated with elevated sympathetic tone are associated with significant morbidity and mortality rates, RDN therapy may be expected to have a significant impact on public health.