Joint UK societies' 2019 consensus statement on renal denervation

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Nephrology

Background:

• Hypertension management is a global priority, with lifestyle changes and antihypertensive drugs being standard treatments.
• Patient adherence to long-term medication and lifestyle modifications remains a significant challenge in hypertension control.
• Endovascular renal denervation (RDN) is an emerging non-pharmacological therapy targeting renal sympathetic nerves to lower blood pressure.

Framework:

• Initial studies on RDN were limited by non-randomized designs and small sample sizes.
• Recent sham-controlled randomized controlled trials (RCTs) have improved study rigor, demonstrating short-term ambulatory blood pressure reduction.
• These RCTs have shown no significant safety concerns in both medication-naïve and medication-treated hypertensive patients.

Implementation:

• RDN utilizes radiofrequency energy or ultrasound to achieve renal sympathectomy.
• The procedure has been evaluated in human clinical trials since 2009.
• Current guidelines recommend RDN only within clinical trial contexts, pending further evaluation.

Implications:

• RDN presents a promising alternative or adjunct to pharmacological and lifestyle interventions for hypertension.
• Further rigorous clinical trials are essential to establish the long-term efficacy and safety of RDN.
• A clear research agenda is needed to guide future studies and inform clinical practice guidelines regarding RDN.