International Expert Consensus Statement: Percutaneous Transluminal Renal Denervation for the Treatment of Resistant Hypertension.
J Am Coll Cardiol. 2013 Sep 6;
Authors: Schlaich MP, Schmieder RE, Bakris G, Blankestijn PJ, Böhm M, Campese VM, Francis DP, Grassi G, Hering D, Katholi R, Kjeldsen S, Krum H, Mahfoud F, Mancia G, Messerli FH, Narkiewicz K, Parati G, Rocha-Singh KJ, Ruilope LM, Rump LC, Sica DA, Sobotka PA, Tsioufis C, Vonend O, Weber MA, Williams B, Zeller T, Esler MD
Catheter-based radiofrequency ablation technology to disrupt both efferent and afferent renal nerves has recently been introduced to clinical medicine following the demonstration of significant systolic and diastolic blood pressure reductions. Clinical trial data available thus far has been obtained primarily in patients with resistant hypertension defined as standardized systolic clinic blood pressure of ≥160mmHg (or ≥150mmHg in type 2 diabetes) despite appropriate pharmacologic treatment with at least 3 antihypertensive drugs including a diuretic. Accordingly, these criteria and blood pressure thresholds should be borne in mind when selecting patients for renal nerve ablation. Secondary forms of hypertension and pseudo-resistance, such as non-adherence with medication, intolerance of medication, and white coat hypertension should have been ruled out and 24-h ambulatory blood pressure monitoring is mandatory in this context. As there are theoretical concerns with regard to renal safety, selected patients should have preserved renal function with an estimated GFR of at least ≥45ml/min/1.73m(2). Optimal peri-procedural management of volume status and medication regimens in specialized and experienced centres equipped with adequate infrastructure to cope with potential procedural complications will minimize potential patient risks. Long-term safety and efficacy data are limited to 3 years of follow up in small patient cohorts, thus efforts to monitor treated patients are crucial to define long term performance of the procedure. While renal nerve ablation could have beneficial effects in other conditions characterized by elevated renal sympathetic nerve activity, its potential use for such indications should currently be limited to formal research studies of its safety and efficacy.
PMID: 24021387 [PubMed - as supplied by publisher]