Renal Denervation for Resistant Hypertension

doi:10.1016/j.pcad.2016.10.003

Progress in Cardiovascular Diseases

Volume 59, Issue 3, November–December 2016, Pages 295-302

https://doi.org/10.1016/j.pcad.2016.10.003 Get rights and content

Abstract

Renal denervation as a treatment for hypertension (HTN) has been shown to be effective as a surgical procedure. Over the past 10 years, an endovascular approach to replicate the results of surgical splanchnicectomy has been investigated to replace this surgical procedure with a less invasive procedure with lower morbidity. Several devices and procedures have been developed, including a non-invasive strategy. We review the improvement of HTN in clinical trials of these devices as well as the shortcomings of these studies. Thus far, these trials have been unable to prove that these renal denervation strategies are superior to medical therapy alone, but we look forward to further randomized, double blinded trials of current systems that can effectively achieve denervation to reduce the risk of HTN.

Section snippets

Renal denervation procedures

In 1938, thoracolumbar splanchnicectomy was first introduced for the treatment of HTN. In 1953, Smithwick and Thompson reported their experience with 1253 patients treated with splanchnicectomy, compared to 467 patients in the control group who were treated with medical therapy. The surgical and medically managed patients with essential HTN were divided into four groups based on the severity of their HTN. For each group, the survival at five years was superior in the surgical group as compared

Results of efficacy trials

The initial results of the open label Symplicity HTN 1 trial were widely greeted as a potential breakthrough technology; 50 patients with treatment resistant HTN were enrolled, and five were excluded for renal anatomy that was not amenable to the procedure. The mean reduction in office BP at 6 months was 22 mm Hg and 11 mm Hg for SBP and DBP, respectively. The reduction in BP was seen as early as one month after the procedure.¹⁴ (Fig 10) The follow up study, HTN 2, was another multicenter, open

Summary

RDN as a treatment for HTN has been shown to be effective as a surgical procedure, splanchnicectomy. Over the past 10 years, investigators sought to develop an endovascular approach to replicate the results of surgical splanchnicectomy with a less invasive procedure with lower morbidity (Fig 12). Several procedures have been developed, including a non-invasive strategy. But to date, investigators have been unable to prove that these RDN strategies are superior to medical therapy alone which is

Statement of conflict of interest

The authors have no conflict of interest to disclose regarding this manuscript.

References (19)

P.A. Smith et al.
Relationship between central sympathetic activity and stages of human hypertension
Am J Hypertens
(2004)
K. Sakakura et al.
Anatomic assessment of sympathetic peri-arterial renal nerves in man
J Am Coll Cardiol
(2014)
C. Stefanadis et al.
New double balloon delivery catheter for chemical denervation of the renal artery with vincristine
Int J Cardiol
(2013)
T.A. Fischell et al.
Transcatheter alcohol-mediated perivascular renal denervation with the peregrine system: first-in-human experience
JACC Cardiovasc Interv
(2016)
P. Neuzil et al.
Externally delivered focused ultrasound for renal denervation
JACC Cardiovasc Interv
(2016)
H. Krum et al.
Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study
Lancet
(2009)
M. Azizi et al.
Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension (denerhtn): a multicentre, open-label, randomised controlled trial
Lancet
(2015)
D. Mozaffarian et al.
Heart disease and stroke statistics--2015 update: a report from the american heart association
Circulation
(2015)
S.D. Persell
Prevalence of resistant hypertension in the United States, 2003-2008
Hypertension
(2011)

There are more references available in the full text version of this article.

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: Statement of Conflict of Interest: see page 301.

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Renal Denervation for Resistant Hypertension

Abstract

Section snippets

Renal denervation procedures

Results of efficacy trials

Summary

Statement of conflict of interest

Am J Hypertens

J Am Coll Cardiol

Int J Cardiol

JACC Cardiovasc Interv

JACC Cardiovasc Interv

Lancet

Lancet

Heart disease and stroke statistics--2015 update: a report from the american heart association

Circulation

Prevalence of resistant hypertension in the United States, 2003-2008

Hypertension