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Review
. 2023 Jan;31(1):3-11.
doi: 10.1007/s12471-022-01717-4. Epub 2022 Aug 24.

The position of renal denervation in treatment of hypertension: an expert consensus statement

V J M Zeijen  1 , A A Kroon  2 , B H van den Born  3 , P J Blankestijn  4 , S C A Meijvis  4 , A Nap  5 , E Lipsic  6 , A Elvan  7 , J Versmissen  8 , R J van Geuns  9 , M Voskuil  10 , P A L Tonino  11 , W Spiering  12 , J Deinum  13 , J Daemen  14
Affiliations
Review

The position of renal denervation in treatment of hypertension: an expert consensus statement

V J M Zeijen et al. Neth Heart J. 2023 Jan.

Abstract

Hypertension is an important risk factor for cardiovascular disease. In the Netherlands, there are approximately 2.8 million people with hypertension. Despite treatment recommendations including lifestyle changes and antihypertensive drugs, most patients do not meet guideline-recommended blood pressure (BP) targets. In order to improve BP control and lower the risk of subsequent cardiovascular events, renal sympathetic denervation (RDN) has been introduced and studied as a non-pharmacological approach. While early data on the efficacy of RDN showed conflicting results, improvements in treatment protocols and study design resulted in robust new evidence supporting the potential of the technology to improve patient care in hypertensive subjects. Recently, 5 randomised sham-controlled trials demonstrated the safety and efficacy of the technology. Modelling studies have further shown that RDN is cost-effective in the Dutch healthcare setting. Given the undisputable disease burden along with the shortcomings of current therapeutic options, we postulate a new, clearly framed indication for RDN as an adjunct in the treatment of hypertension. The present consensus statement summarises current guideline-recommended BP targets, proposed workup and treatment for hypertension, and position of RDN for those patients with primary hypertension who do not meet guideline-recommended BP targets (see central illustration).

Keywords: Consensus; Hypertension; Netherlands; Patient care; Sympathectomy.

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Conflict of interest statement

V.J.M. Zeijen received institutional grant/research support from ReCor Medical. J. Daemen received institutional grant/research support from Astra Zeneca, Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Microport, Pie Medical, and ReCor medical. A.A. Kroon, B.H. van den Born, P.J. Blankestijn, S.C.A. Meijvis, A. Nap, E. Lipsic, A. Elvan, J. Versmissen, R.J. van Geuns, M. Voskuil, P.A.L. Tonino, W. Spiering and J. Deinum declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart for the positioning of RDN in clinical practice. (*According to 2018 ESC/ESH Guidelines for the management of arterial hypertension [9]. BP blood pressure, sOBP systolic office blood pressure, dOBP diastolic office blood pressure, sABP systolic ambulatory blood pressure, dABP diastolic ambulatory blood pressure, RDN renal sympathetic denervation, ESC European Society of Cardiology, ESH European Society of Hypertension)
See this image and copyright information in PMC

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