Renal denervation as therapy for hypertension: potentials and unanswered questions

Abstract

In 2005, cardiovascular diseases globally accounted for 30% of an estimated total of 58 million deaths. Hypertension is one of the major contributors to these events. Unfortunately, about two-thirds of all hypertensive patients do not reach treatment goals despite maximal drug treatment. Percutaneous catheter-based renal denervation as a therapy for uncontrolled hypertension is an intriguing idea, especially for patients with resistant hypertension. The first short-term results from a randomized trial are promising: 84% of the patients had a blood pressure (BP) reduction of ≥10 mmHg and 39% had a systolic BP of ≤140 mmHg 6 months after treatment. However, several questions remain unanswered. To gain more insight, initiatives should be started aiming at assessing safety of the treatment, sustainability of the BP-lowering effect, cost-effectiveness, and the effect on cardiovascular event rate. Many European centres have now started to perform renal denervation or are in the process of starting it up. Therefore, we call for an international collaboration effort to compose cohorts and conduct randomized trials to address the remaining issues at this point in time.

Keywords: Hypertension; radioablation; renal denervation; resistant hypertension; sympathetic ablation.