Renal Denervation in High-risk Patients with Hypertension

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Nephrology

Background:

• Hypertension poses a significant global health burden, with treatment-resistant cases presenting a major clinical challenge.
• Management of high-risk and resistant hypertension requires innovative therapeutic approaches.
• Renal sympathetic nerve activity plays a crucial role in the pathophysiology of hypertension.

Purpose of the Study:

• To review the evidence for renal denervation (RD) in hypertension management.
• To discuss the current clinical role and future evolution of RD.
• To address gaps in the evidence base for RD.

Main Methods:

• Review of randomized, non-randomized, sham-controlled, and non-sham-controlled trials.
• Analysis of studies evaluating endovascular delivery of heat energy to renal sympathetic nerves.
• Examination of recent trials designed to overcome limitations of earlier studies.

Main Results:

• Earlier trials yielded inconclusive results, creating clinical equipoise regarding RD efficacy.
• More recent trials (e.g., SPYRAL HTN-OFF MED, SPYRAL HTN-ON MED, RADIANCE-HTN SOLO) provide support for RD's effectiveness.
• RD can lead to blood pressure reduction, with or without adjunctive antihypertensive pharmacotherapy.

Conclusions:

• Renal denervation is an emerging technique with demonstrated efficacy in managing hypertension.
• Further research is needed to define the optimal role and long-term outcomes of RD.
• The clinical application and evidence base for RD in hypertension are expected to evolve.