Device-based approaches for renal nerve ablation for hypertension and beyond

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Chronic activation of renal sympathetic nerves contributes to treatment-resistant hypertension.
• Bilateral renal denervation ablates renal nerves to lower blood pressure, offering a non-pharmacological approach.
• Recent trials have questioned the efficacy of renal denervation compared to sham procedures.

Purpose of the Study:

• To review the pathological rationale for targeting renal sympathetic nerves.
• To discuss advancements in renal nerve ablation techniques.
• To explore the efficacy of renal denervation for hypertension and other conditions.

Main Methods:

• Review of animal and human studies.
• Analysis of recent randomized controlled trials.
• Discussion of pre-clinical and proof-of-concept studies.

Main Results:

• Renal denervation's role in hypertension pathogenesis is established.
• Recent trials have yielded conflicting results regarding blood pressure reduction.
• Studies suggest potential cardiovascular and metabolic benefits independent of blood pressure changes.

Conclusions:

• Renal denervation's efficacy for resistant hypertension requires further investigation.
• Targeting renal sympathetic nerves may offer benefits in conditions with central sympathetic overactivity.
• Advancements in ablation modalities aim to improve procedural success and therapeutic outcomes.