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Opportunities and Limitations of Renal Denervation: Where Do We Stand?
Beatriz Castillo Rodriguez1, Eric A Secemsky2, Rajesh V Swaminathan3
1Division of Internal Medicine, Baylor College of Medicine, Houston, Texas.
Insights
Renal denervation effectively lowers blood pressure in patients with uncontrolled hypertension. This review covers major trials and guidelines on this interventional therapy for resistant hypertension.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Hypertension is a leading cause of cardiovascular disease and mortality.
- Uncontrolled and resistant hypertension affect a significant portion of the population.
- Percutaneous renal denervation is an emerging treatment for refractory hypertension.
Purpose of the Study:
- To review major randomized sham-controlled trials on renal denervation.
- To summarize societal guidelines on renal denervation efficacy and safety.
- To assess the role of renal denervation in managing uncontrolled hypertension.
Main Methods:
- Review of randomized controlled trials (RCTs) including sham-controlled studies.
- Analysis of registry data and societal guidelines.
- Focus on various renal denervation techniques (radiofrequency, ultrasound, ethanol).
Main Results:
- Initial trials showed promise, but early sham-controlled trials had mixed results.
- Refined techniques and newer RCTs demonstrate significant blood pressure reduction.
- Radiofrequency and ultrasound denervation technologies have received FDA approval.
Conclusions:
- Renal denervation is a viable option for select patients with uncontrolled hypertension.
- Evolving techniques have improved the efficacy and safety of the procedure.
- Further research and adherence to guidelines are crucial for optimal patient outcomes.
Abstract:
Hypertension is a primary contributor to cardiovascular disease, and the leading risk factor for loss of quality adjusted life years. Up to 50% of the cases of hypertension in the United States remain uncontrolled. Additionally, 8%-18% of the hypertensive population have resistant hypertension; uncontrolled pressure despite 3 different antihypertensive agents. Recently, catheter-based percutaneous renal denervation emerged as a method for ablating renal sympathetic nerves for difficult-to-control hypertension. Initial randomized (non-sham) trials and registry analyses showed impressive benefit, but the first sham-controlled randomized controlled trial using monopolar radiofrequency ablation showed limited benefit. With refinement of techniques to include multipolar radiofrequency, ultrasound denervation, and direct ethanol injection, randomized controlled trials demonstrated significant blood pressure improvement, leading to US Food and Drug Administration approval of radiofrequency- and ultrasound-based denervation technologies. In this review article, we summarize the major randomized sham-controlled trials and societal guidelines regarding the efficacy and safety of renal artery denervation for the treatment of uncontrolled hypertension.
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