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. 2019 Oct;105(19):1456-1463.
doi: 10.1136/heartjnl-2019-315098. Epub 2019 Jul 10.

Joint UK societies' 2019 consensus statement on renal denervation

Melvin D Lobo  1   2 , Andrew S P Sharp  3   4 , Vikas Kapil  1   2 , Justin Davies  5 , Mark A de Belder  6   7 , Trevor Cleveland  8 , Clare Bent  9 , Neil Chapman  5 , Indranil Dasgupta  10 , Terry Levy  9 , Anthony Mathur  1   2 , Matthew Matson  11 , Manish Saxena  1   2 , Francesco P Cappuccio  12   13 ; British & Irish Hypertension Society, the British Cardiovascular Society, the British Cardiovascular Intervention Society, the British Society of Interventional Radiology and the Renal Association
Collaborators, Affiliations

Joint UK societies' 2019 consensus statement on renal denervation

Melvin D Lobo et al. Heart. 2019 Oct.

Abstract

Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. There are several lifestyle measures that are proven to result in improved blood pressure (BP) control. Moreover, there is incontrovertible evidence from large scale randomised controlled trials (RCTs) that antihypertensive drugs lower BP safely and effectively in the long-term resulting in substantial reduction in cardiovascular morbidity and mortality. Importantly, however, evidence is accumulating to suggest that patients neither sustain long-term healthy behaviours nor adhere to lifelong drug treatment regimens and thus alternative measures to control hypertension warrant further investigation. Endovascular renal denervation (RDN) appears to hold some promise as a non-pharmacological approach to lowering BP and achieves renal sympathectomy using either radiofrequency energy or ultrasound-based approaches. This treatment modality has been evaluated in clinical trials in humans since 2009 but initial studies were compromised by being non-randomised, without sham control and small in size. Subsequently, clinical trial design and rigour of execution has been greatly improved resulting in recent sham-controlled RCTs that demonstrate short-term reduction in ambulatory BP without any significant safety concerns in both medication-naïve and medication-treated hypertensive patients. Despite this, the joint UK societies still feel that further evaluation of this therapy is warranted and that RDN should not be offered to patients outside of the context of clinical trials. This document reviews the updated evidence since our last consensus statement from 2014 and provides a research agenda for future clinical studies.

Keywords: hypertension; interventional cardiology and endovascular procedures.

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Conflict of interest statement

Competing interests: MDL is funded by the Barts Charity and is a consultant to: Medtronic, Ablative Solutions, ReCor Medical, Vascular Dynamics, ROX Medical, Tarilian Laser Technologies and has received speaker fees from CVRx. AS is a consultant for Medtronic and Recor Medical and has received speaker fees from Medtronic. VK is funded by the Barts Charity. JD has served as a consultant for and has received significant research funding from Volcano Corporation; has received grants and personal fees from Medtronic, ReCor Medical and AstraZeneca; and is the co-inventor of the instantaneous wave-free ratio (iFR) and holds patents pertaining to this. MAdB has participated in an advisory board for Medtronic. NC is an investigator for the SPYRAL and RADIANCE studies and has received speaker fees from Medtronic and ReCor Medical. ID has received an unrestricted research grant from Medtronic. MS has received speaker fees from Recor Medical. FPC is president and trustee of the British and Irish Hypertension Society. He is head of a WHO collaborating centre and a scientific advisor to the WHO in areas unrelated to renal denervation. All other authors have reported that they have no relationships relevant to the contents of this paper.

Figures

Figure 1
Figure 1
24 Hour ambulatory systolic blood pressure reduction in Spyral HTN-OFF MED and HTN-ON MED, RADIANCE-HTN SOLO and SYMPLICITY HTN-3 randomized clinical trials. Data shown as mean±SEM. (Δ=change from baseline; ASBP=Ambulatory systolic blood pressure; RDN=renal denervation).
See this image and copyright information in PMC

Comment in

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