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Renal denervation: unde venis et quo vadis?
Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|January 29, 2015
Summary
Renal denervation shows limited efficacy for refractory hypertension, with initial trials showing significant blood pressure reduction not confirmed in randomized studies. Further evaluation is needed before widespread use outside clinical trials.
Area of Science:
- Cardiology
- Nephrology
- Interventional Radiology
Background:
- Refractory hypertension affects a small percentage of hypertensive patients.
- Renal denervation is a minimally invasive procedure targeting the renal sympathetic nerves.
- Established indications and contraindications guide its use.
Purpose of the Study:
- To evaluate the efficacy and safety of renal denervation for treating refractory hypertension.
- To assess the procedure's effectiveness in patients with primary hypertension and diabetes mellitus type 2.
- To determine if renal denervation offers superior outcomes compared to optimal medical therapy.
Main Methods:
- Review of indications and contraindications for renal denervation.
- Analysis of results from non-randomized and randomized controlled trials.
- Comparison of blood pressure reduction in renal denervation versus sham procedures.
Main Results:
- Non-randomized trials indicated an average blood pressure reduction of 32/14 mmHg.
- The first randomized controlled trial showed a non-significant blood pressure reduction of 14.1 mmHg compared to controls.
- Office blood pressure decreased significantly, but 24-hour ambulatory blood pressure impact remains unclear.
Conclusions:
- Efficacy and long-term effects of renal denervation require re-evaluation, particularly after the HTN3 study.
- Renal denervation should be limited to clinical trials currently.
- Further research is needed to assess safety and efficacy in hypertension-associated diseases and as an alternative therapy.
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