Renal denervation for hypertension: observations and predictions of a founder.

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Renal denervation for hypertension: observations and predictions of a founder.

Eur Heart J. 2014 Mar 4;

Authors: Esler M

The 6-year anniversary of the first catheter-based renal denervation procedure for resistant hypertension has passed, and the 3-year follow-up results of the Symplicity HTN-1 are now published. At the 'end of the beginning', it is timely to reflect on the observations to-date for this revolutionary therapy, and to predict the next phase in its development and clinical application in hypertension treatment. In essence, on observations to hand, the procedure is efficacious and seems safe and durable. But will the blood pressure lowering truly be permanent (or might it be cancelled out by renal sympathetic nerve regrowth)? How can patient selection for the renal denervation procedure be optimized, given that some patients do not respond with a blood pressure fall? Will blood pressure lowering with renal denervation reduce the rate of clinical cardiovascular endpoints? Will long-term safety be acceptable? Can milder hypertension be cured? And there are unresolved procedural and technical questions: how much renal denervation is optimal; is unilateral denervation, now commonly used, beneficial; will renal denervation show a 'class effect', with the different energy forms now used for renal nerve ablation producing equivalent blood pressure lowering? At the 12-year anniversary, I expect these questions will be answered, and catheter-based renal denervation will have an established clinical role in the care of patients with severe grades of hypertension. Less certain is the common prediction of its application in early, mild hypertension, in parallel with, or even before anti-hypertensive drug prescribing.

PMID: 24598982 [PubMed - as supplied by publisher]


  1. In my opinión the major problem to renal denervation continue to be the selection of patients. Apart the confirmation of true resistant hypertension (ABPM and presence of TOD), we need to optimize antihypertensive treatment by confirming compliance and using adequate number of drugs (of course not only 3), doses and daily therapeutic scheme. After that the number of really true hypertensive patients resistant to pharmacological treatment is around 2-3%. This percentage means not only a signifcant number of candidates to RSD, but also make the procedure cost-effective for sanitary administrations.

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