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Review
. 2015 Oct-Dec;11(4):240-4.
doi: 10.14797/mdcj-11-4-240.

Resistant Hypertension and Renal Nerve Denervation

Matthew G Denker  1 , Debbie L Cohen  1
Affiliations
Review

Resistant Hypertension and Renal Nerve Denervation

Matthew G Denker et al. Methodist Debakey Cardiovasc J. 2015 Oct-Dec.

Abstract

Patients with resistant hypertension are a subgroup of the hypertensive population that are at even greater risk of cardiovascular outcomes. Therapeutic options for these patients are limited to antihypertensive medications. However, renal denervation (RDN) is a novel nonpharmacologic intervention that involves a catheter-based ablation of the sympathetic nerves within the renal artery wall. The procedure initially showed promise with remarkable blood pressure reductions until the pivotal SYMPLICITY HTN-3 trial failed to demonstrate superiority of RDN over control. This trial was notable for a substantial placebo effect and an attenuated response to RDN. These findings, which contradicted those of prior studies, have raised numerous questions, including whether adequate RDN occurred in those patients. Further research is planned to resolve some of these questions and to clarify the role of RDN in treating patients with resistant hypertension.

Keywords: blood pressure; renal denervation; resistant hypertension; sympathetic nervous system.

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Figures

None
M. G. Denker, M.D.
None
D. L. Cohen, M.D.
Figure 1.
Figure 1.
The physiological effects of activating efferent and afferent renal sympathetic nerves. Reprinted from Huan et al. with permission from Wiley.
Figure 2.
Figure 2.
The distribution of renal sympathetic nerves within and along the renal artery wall. Each green dot represents 10 nerves. Percentages denote the relative number of nerves according to distance from the lumen in each cross-sectional segment of the artery wall and in (A) proximal, (B) middle, and (C) distal locations. Reprinted from Mahfoud et al. with permission from Elsevier.
See this image and copyright information in PMC

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