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renal nerve ablation; renal sympathetic denervation

Indications: - persistent hypertension not responsive to medical therapy [1,2] Procedure: - radiofrequency ablation within each renal artery Complications: - renal artery dissection - pseudoaneurysm at the femoral access site Notes: - did not lower blood pressure significantly in a sham-controlled trial [3] - trials to continue after the catheters modified [4] - did lower blood pressure significantly in a sham-controlled trial [5] - lowered systolic blood pressure 9.0 vs 1.6 & 8.5 vs 2.2 mm Hg in 2 sham controlled trials [6] - delaying renal denrvation does not diminish anit-hypertensive effectiveness of procedure [7] - sustained blood pressure reduction with use of multiple antihypertensives [8] - blood pressure reduction is variable, reductions of systolic BP of ~ 5 mm Hg observed in many trials [9] - systolic BP reductions of > 10 mm Hg not observed in recent sham controlled trials [9]

General

clinical procedure

References

  1. Krum H et al. Catheter-based renal sympathetic denervation for resistant hypertension: A multicentre safety and proof-of-principle cohort study. Lancet 2009 Mar 30; [e-pub ahead of print] http://dx.doi.org/10.1016/S0140-6736(09)60566-3 - Doumas M and Douma S. Interventional management of resistant hypertension. Lancet 2009 Mar 30; [e-pub ahead of print]. http://dx.doi.org/10.1016/S0140-6736(09)60624-3 - Krum H et al. Percutaneous renal denervation in patients with treatment- resistant hypertension: Final 3-year report of the Symplicity HTN-1 study. Lancet 2013 Nov 7 PMID: 24210779
  2. Brandt MC et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012 Mar 6; 59:901. PMID: 22381425 - Zile MR and Little WC. Effects of autonomic modulation: More than just blood pressure. J Am Coll Cardiol 2012 Mar 6; 59:910. PMID: 22381426
  3. Bhatt DL, Kandzari DE, O'Neill WW et al SYMPLICITY HTN-3 Investigators. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014 Apr 10;370(15):1393-401 PMID: 246789393 - Bhatt DL, Bakris GL. Renal denervation for resistant hypertension. N Engl J Med. 2014 Jul 10;371(2):184. PMID: 25006731
  4. Husten L, Sadough S, Sofair A Companies Plan To Resume Renal Denervation Trials Physician's First Watch, Feb 23, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  5. Townsend RR, Mahfoud F, Kandzari DE et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): A randomised, sham-controlled, proof-of-concept trial. Lancet. 2017 Aug 25. pii: S0140-6736(17)32281-X PMID: 28859944 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32281-X/fulltext - Azizi M. Catheter-based renal denervation for treatment of hypertension. Lancet 2017 Aug 28 PMID: 28859945 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32293-6/fulltext
  6. Kandzari DE, Bohm M, Mahfoud F et al Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial/ Lancet. May 23, 2018 PMID: 29803589 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30951-6/fulltext - Azizi M, Schmieder RE, Mahfoud F et al Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet. May 23, 2018 PMID: 29803590 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31082-1/fulltext - Blankestijn PJ, Bots ML Renal denervation in uncontrolled hypertension: the story continues to unfold. Lancet. May 23, 2018 PMID: 29803591 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31112-7/fulltext - Kjeldsen SE, Esler MD Take a blood pressure pill or undergo renal denervation? Lancet. May 23, 2018 PMID: 29803587 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31126-7/fulltext
  7. Lou N Renal Denervation: No Rush for BP-Lowering Benefit = RADIANCE-HTN SOLO data suggest a little more time for med optimization does no harm. MedPage Today June 26, 2020 https://www.medpagetoday.com/meetingcoverage/europcr/87309
  8. Sesa-Ashton G, Nolde JM, Muente I, et al. Long-term blood pressure reductions following catheter-based renal denervation: A systematic review and meta-analysis. Hypertension 2024 Mar 20; [e-pub]. PMID: 38506059 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.22314
  9. Cluett JL, Blazek O, Brown AL et al. Renal denervation for the treatment of hypertension: A scientific statement from the American Heart Association. Hypertension 2024 Oct; 81:e135 PMID: 39101202 Free article. Review. https://www.ahajournals.org/doi/10.1161/HYP.0000000000000240